Root Cause Analysis of Delayed Emergency Department Computed Tomography Scans.

Autor: Dhanik A; Beth Israel Deaconess Medical Center, Department of Emergency Medicine, Boston, Massachusetts.; Harvard Medical School, Harvard University, Boston, Massachusetts.; Co-first authors who equally contributed to this work., Stenson BA; Beth Israel Deaconess Medical Center, Department of Emergency Medicine, Boston, Massachusetts.; Harvard Medical School, Harvard University, Boston, Massachusetts.; Co-first authors who equally contributed to this work., Levenson RB; Beth Israel Deaconess Medical Center, Department of Emergency Medicine, Boston, Massachusetts.; Harvard Medical School, Harvard University, Boston, Massachusetts., Antkowiak PS; Beth Israel Deaconess Medical Center, Department of Emergency Medicine, Boston, Massachusetts.; Harvard Medical School, Harvard University, Boston, Massachusetts., Sanchez LD; Harvard Medical School, Harvard University, Boston, Massachusetts.; Brigham and Women's Faulkner Hospital, Department of Emergency Medicine, Boston, Massachusetts., Chiu DT; Beth Israel Deaconess Medical Center, Department of Emergency Medicine, Boston, Massachusetts.; Harvard Medical School, Harvard University, Boston, Massachusetts.
Jazyk: angličtina
Zdroj: The western journal of emergency medicine [West J Emerg Med] 2024 Mar; Vol. 25 (2), pp. 226-229.
DOI: 10.5811/westjem.17831
Abstrakt: Introduction: A solution for emergency department (ED) congestion remains elusive. As reliance on imaging grows, computed tomography (CT) turnaround time has been identified as a major bottleneck. In this study we sought to identify factors associated with significantly delayed CT in the ED.
Methods: We performed a retrospective analysis of all CT imaging completed at an urban, tertiary care ED from May 1-July 31, 2021. During that period, 5,685 CTs were performed on 4,344 patients, with a median time from CT order to completion of 108 minutes (Quartile 1 [Q1]: 57 minutes, Quartile 3 [Q3]: 182 minutes, interquartile range [IQR]: 125 minutes). Outliers were defined as studies that took longer than 369 minutes to complete (Q3 + 1.5 × IQR). We systematically reviewed outlier charts to determine factors associated with delay and identified five factors: behaviorally non-compliant or medically unstable patients; intravenous (IV) line issues; contrast allergies; glomerular filtration rate (GFR) concerns; and delays related to imaging protocol (eg, need for IV contrast, request for oral and/or rectal contrast). We calculated confidence intervals (CI) using the modified Wald method. Inter-rater reliability was assessed with a kappa analysis.
Results: We identified a total of 182 outliers (4.2% of total patients). Fifteen (8.2%) cases were excluded for CT time-stamp inconsistencies. Of the 167 outliers analyzed, 38 delays (22.8%, 95% confidence interval [CI] 17.0-29.7) were due to behaviorally non-compliant or medically unstable patients; 30 (18.0%, 95% CI 12.8-24.5) were due to IV issues; 24 (14.4%, 95% CI 9.8-20.6) were due to contrast allergies; 21 (12.6%, 95% CI 8.3-18.5) were due to GFR concerns; and 20 (12.0%, 95% CI 7.8-17.9) were related to imaging study protocols. The cause of the delay was unknown in 55 cases (32.9%, 95% CI 26.3-40.4).
Conclusion: Our review identified both modifiable and non-modifiable factors associated with significantly delayed CT in the ED. Patient factors such as behavior, allergies, and medical acuity cannot be controlled. However, institutional policies regarding difficult IV access, contrast administration in low GFR settings, and study protocols may be modified, capturing up to 42.6% of outliers.
Competing Interests: Conflicts of Interest: By the WestJEM article submission agreement, all authors are required to disclose all affiliations, funding sources and financial or management relationships that could be perceived as potential sources of bias. No author has professional or financial relationships with any companies that are relevant to this study. There are no conflicts of interest or sources of funding to declare.
Databáze: MEDLINE
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