scholarly journals P128: Emergency physician efficiency benchmarking and diagnostic imaging use

CJEM ◽  
2020 ◽  
Vol 22 (S1) ◽  
pp. S110-S110
Author(s):  
S. Weerasinghe ◽  
N. Chandratilleke ◽  
S. Campbell
Keyword(s):  
Diagnostic Imaging ◽  
Optimal Performance ◽  
Audit And Feedback ◽  
X Rays ◽  
X Ray ◽  
Use Of Resources ◽  
Quartile Range ◽  
Workload Measurement ◽  
Number Of Patients ◽  
Return Visits

Introduction: As part of our audit and feedback process, Emergency Physicians (EP) are provided feedback on flow metrics and resource utilization. We analysed the relationship between two specific metrics (adjusted workload measurement (AWM), with the number of patients seen per hour adjusted according to CTAS, and percentage of revisits within 72 hours and diagnostic imaging use. Unfortunately, we are unable to evaluate quality of care, nor appropriateness of DI indication at this stage. Methods: We used data from 86 physicians at an academic ED, from June 1, 2015 to May31, 2017. The Data Envelope Analysis (DEA) model incorporated performance quality measures as outputs and efficiency measures as inputs. DEA is a method widely used in physician performance analysis. The method provides a score (optimal performance efficiency-OPE) for each EP based on maximization of the performance (AWM) in proportion to the combination of efficient use of resources, diagnostic imaging (DI). The score was used to regress against demographic characteristics and training. Results: The median AWM was 6.8 (quartiles Q1-Q3 = 6.4-7.4) with the median diagnostic imaging use of percentages of CT (median = 10.1, 8.6-11.9), US (median = 4.7, 3.6-5.6) and x-ray (80, 74-84). The EPs who had highest AWM combined with least use of DI (OPE = 100%), provided median AWM of 9.1 (range 8.9-9.7) with percentage CT, US and x-ray medians at 5.8% (range 5.8-6.2), 2.7% (range 2.4-3.6) and 59% (range 59-72). These provided benchmarks for optimal performance indicators. We found statistically significant differences of OPE scores based on gender (men 4.1 times higher, p < 0.001) and degree (RCPS < CCFPEM, Other < CCFPEM, p < 0.001). Overall AWM diminishes at the rate of 14% (95%CI: 9-20%) for a combination of 100 DI tests ordered. In order to reach the optimal level of performance, to reach an OPE of 100%, the median CT use percentage needs to be reduced by 6% (quartile range 3.9- 7.7%), US by 2.2% (quartile range 1.5-3.4%) and x-rays by 37.2% (quartile range: 26.8-44.3%). Return visit rates were not associated with DI use, possibly due to homogeneity in the percentage of return visits. Conclusion: We found significant performance variations in terms of average workload measurement in proportion to the weighted average of diagnostic imaging use, with increased use of DI being associated with decreasing AWM. Percentage of return visits does not appear to be useful as a performance indicator.

scholarly journals LO68: Patterns and predictors of emergency physician productivity

CJEM ◽  
2018 ◽  
Vol 20 (S1) ◽  
pp. S30-S31
Author(s):  
S. Campbell ◽  
S. Weerasinghe
Keyword(s):  
Emergency Department ◽  
Quality Of Care ◽  
Ct Scan ◽  
Resource Utilization ◽  
Emergency Physician ◽  
X Ray ◽  
Workload Measurement ◽  
Number Of Patients ◽  
Return Visits

Introduction: Emergency Physician (EP) performance comprises both quality of care and quantity of patients seen in a set time. Emergency Department (ED) overcrowding increases the importance of the ability of EPs to see patients as rapidly as is safely possible. Maximizing efficiency requires an understanding of variables that are associated with individual physician performance. While using the incidence of return visits within 48 hours as a quality measure is controversial, repeat visits do consume ED resources. Methods: We analysed the practice variables of 85 EPs working at a single academic ED, for the period from June 1, 2013 to May 31, 2017, using data from an emergency department information system (EDIS). Variables analysed included: number of shifts worked, number of patients seen per hour (pt/hr), an adjusted workload measurement (assigning a higher score to CTAS 1-3 patients), percentage of patients whose care involved an ED learner, and the percentage of patients who returned to the ED within 48 hours of ED discharge. Resource utilization was measured by percentage of diagnostic imaging (ultra sound (US), CT scan (CT), x-ray (XR)) ordered and percentage of patients referred to consulting services. We performed principal component analyses to identify bench marks of resource use, demographic (age, EM qualification, gender) and other practice related predictors of performances. Results: Mean pt/hr differed significantly by EM Qualification for CTAS 2-4, with 1.71/hr (95% Confidence Interval=1.63-1.77) by FRCPS physicians, compared to 1.89/hr by CCFP(EM) (CI=1.81-1.97). There were no differences for CTAS 1 and 5. Other variables associated with a significantly lower pt/hr, included a greater use of imaging, (CT: p=0.0003, XR: p=0.0008) although this was did not reach statistical significance with US (p=0.06%). Female gender, older age, number of patient consultations for CTAS 3 and more patients seen by a learner were all associated with lower pt/hr. Pt/hr was a better predictor (R2=45%) for EP resource utilization than adjusted workload measurement (R2 =35%). Higher use of CT was associated with fewer return visits in <48 hrs (0.13% lower). Male gender, younger age, number of patient consultation for CTAS 3 and fewer patients seen by a learner were all associated with an increase in return visits. Conclusion: We found a significant difference in pt/hr rates and return visits within 48 hours between EPs with different age ranges, gender, and EM certification. Increased use of CT scan and x-ray, and consultation for patients CTAS 3 were associated with lower pt/hr. Return visit rates also varied in association with diagnostic imagine use, age, gender and number of patients seen by a learner. Further research is needed to assess the association with these variables on quality of care.

scholarly journals P016: Low risk ankle rule, high reward-a quality improvement initiative to reduce ankle x-rays in the pediatric emergency department

CJEM ◽  
2017 ◽  
Vol 19 (S1) ◽  
pp. S83 ◽  
Author(s):  
F. Al-Sani ◽  
M. Ben-Yakov ◽  
G. Harvey ◽  
J. Gantz ◽  
D. Jacobson ◽  
...  
Keyword(s):  
Emergency Department ◽  
Quality Improvement ◽  
Tertiary Care ◽  
Pediatric Emergency ◽  
Ankle Injuries ◽  
Pediatric Emergency Department ◽  
X Rays ◽  
X Ray ◽  
Return Visits ◽  
Unnecessary Testing

Introduction: Our tertiary care institution embarked on the Choosing Wisely campaign to reduce unnecessary testing, and selected the reduction of ankle x-rays as part of its top five priority initiatives. The Low Risk Ankle Rule (LRAR), an evidence-based decision rule, has been derived and validated to clinically evaluate ankle injuries which do not require radiography. The LRAR, is cost-effective, has 100% sensitivity for clinically important ankle injuries and reduces ankle imaging rates by 30-60% in both academic and community setting. Our objective was to significantly reduce the proportion of ankle x-rays ordered for acute ankle injuries presenting to our pediatric Emergency Department (ED). Methods: Medical records were reviewed for all patients presenting to our tertiary care pediatric ED (ages 3- 18 years) with an isolated acute ankle injury from Jan 1, 2016-Sept 30, 2016. Children with outside imaging, an injury that occurred &gt;72 hours prior, or those who had a repeat ED visit for same injury were excluded. Quality improvement (QI) initiatives included multidisciplinary staff education about the LRAR, posters placed within the ED highlighting the LRAR, development of a new diagnostic imaging requisition for ankle x-rays requiring use of the LRAR and collaboration with the Division of Radiology to ensure compliance with new requisition. The proportion of patients presenting to the ED with acute ankle injuries who received x-rays was measured. ED length of stay (LOS), return visits to the ED and orthopedic referrals were collected as balancing measures. Results: At baseline 88% of patients with acute ankle injuries received x-rays. Following our multiple interventions, the proportion of x-rays decreased significantly to 54%, (p&lt;0.001). This decrease in x-ray rate was not associated with an increase in ED LOS, ED return visits or orthopedic referrals. There was an increase uptake of the dedicated x-ray requisition over time to 71%. Conclusion: This QI initiative to increase uptake of the LRAR, resulted in a significant reduction of ankle x-rays rates for children presenting with acute ankle injuries in our pediatric ED without increasing LOS, return visits or need for orthopedic referrals for missed injuries. Just as in the derivation and validation studies, the reductions have been sustained and reduced unnecessary testing and ionizing radiation.

scholarly journals LO008: Assessment of the need for diagnostic imaging in extremity injuries by advanced care paramedics

CJEM ◽  
2016 ◽  
Vol 18 (S1) ◽  
pp. S32-S33
Author(s):  
P. Froese ◽  
M.B. Butler ◽  
S.G. Campbell ◽  
K. Magee ◽  
R.P. Mackinley
Keyword(s):  
Diagnostic Imaging ◽  
Patient Flow ◽  
Body Part ◽  
Initial Assessment ◽  
X Rays ◽  
Convenience Sample ◽  
Predictive Values ◽  
X Ray ◽  
Subsequent Test ◽  
Extremity Injuries

Introduction: Emergency department (ED) crowding is a national challenge. Initiatives to help address this at our ED include the use of a six-bed fast-track unit staffed by advanced-care paramedics (ACPs). Institutional byelaws only allow diagnostic imaging (DI) ordering by physicians (MD). An ACP requesting DI at the time of first assessment would likely improve patient flow. We investigated whether ACPs can safely and cost-effectively request DI for extremity injuries without increasing cost or exposing patients to unnecessary radiation. Methods: A prospective evaluation of a convenience sample of patients presenting with an extremity injury sustained within 48 hours of presentation. At time of initial assessment, the ACP, following specific guidelines, recorded whether or not they believed an x-ray was indicated, and if so, what DI views they felt appropriate. Their opinion was blinded from the physician subsequently assessing the patient. An ACP opinion of the need for DI was compared with the subsequent test ordered by the MD. The MD decision to order DI was considered ‘gold standard’. Opinions were considered “matched” if the MD ordered DI of the same body part that the ACP believed was indicated. Sensitivity, specificity, positive predictive and negative predictive values (PPV, NPV) were calculated. Using data from our ED information system, we estimated the time that would have been saved by allowing ACPs to order DI. Results: Of 199 patients 192 images were ordered and 89 fractures were diagnosed. ACPs and MDs agreed that DI was necessary 94.70% of the time (95% CI: {90.6%, 97.4%}). There were 8 x-rays the ACP did not order that the MD did order, of which one showed a fracture. Twice, the ACP would have ordered an x-ray that the MD did not. In terms of identifying the need for DI, ACPs were 95.8% sensitive and 71.4% specific. The PPV was 98.9% (95% CI: {95.8%, 99.8%}), and the NPV was 38.5% (95% CI: {15.1%, 67.7%}). On average, ACP opinion of DI indication was made 54.1 minutes (95% CI: {48.0, 60.2}) earlier that of the MD. Conclusion: The overall agreement between MDs and ACPs was almost 95%. ACPs are more likely to under-order x-rays than to over-order them, lowering the risk of increasing radiation exposure and cost. ACP DI ordering may decrease the time of processing of patients with extremity injuries by almost an hour.

scholarly journals Role of early CT scan in diagnosis of occult scaphoid fractures- a prospective study

2017 ◽  
Vol 5 (9) ◽  
pp. 4072
Author(s):  
Omeshwar Singh ◽  
Anuradha Sen ◽  
Sumeet Singh Charak ◽  
Shakeel Ahmad
Keyword(s):  
Ct Scan ◽  
Tertiary Care ◽  
False Negative ◽  
False Negative Rate ◽  
Scaphoid Bone ◽  
X Rays ◽  
X Ray ◽  
Scaphoid Fractures ◽  
Number Of Patients

Background: Wrists injuries are one of the common presentations to emergency departments and orthopaedic clinics. The scaphoid bone is the most commonly injured of the carpal bones accounting for 50-80% of carpal injuries and predominantly occurs in young healthy individuals. Scaphoid fractures are the most problematic to diagnose in a clinical setting because it can take up to 6 weeks for scaphoid fractures to become conclusive on plain X-ray films. Aim of the study was to retrospective study was carried out to study the role of early CT scan in diagnosis of occult scaphoid fractures.Methods: A total of 123 patients presented with an acute wrist injury with subsequent signs of scaphoid injury in the absence of a diagnostic fracture on plain X-ray within the time period from June 2014 to May 2016 in a tertiary care centre.Results: This study shows that 31% of normal X-rays were pathological on CT scan and out of these; scaphoid fractures (74% of pathologies) represent a large number of patients with fractures that were missed by initial plain films.Conclusions: This study shows an extremely high false-negative rate for plain X-rays and advocate CT at the first attendance to fracture clinic if there is suspicion of scaphoid injury. An earlier diagnosis leads to appropriate management and reduces restrictions to the patient in terms of prolonged immobilization and repeated clinical reviews.

scholarly journals Are We Overdoing It? Changes in Diagnostic Imaging Workload during the Years 2010–2020 including the Impact of the SARS-CoV-2 Pandemic

Healthcare ◽  
2021 ◽  
Vol 9 (11) ◽  
pp. 1557
Author(s):  
Mateusz Winder ◽  
Aleksander Jerzy Owczarek ◽  
Jerzy Chudek ◽  
Joanna Pilch-Kowalczyk ◽  
Jan Baron
Keyword(s):  
Healthcare Expenditure ◽  
University Hospital ◽  
X Rays ◽  
X Ray ◽  
Number Of Patients ◽  
The Future ◽  
The Mean ◽  
The Impact ◽  
Annual Amount ◽  
Related Increase

Since the 1990s, there has been a significant increase in the number of imaging examinations as well as a related increase in the healthcare expenditure and the exposure of the population to X-rays. This study aimed to analyze the workload trends in radiology during the last decade, including the impact of COVID-19 in a single university hospital in Poland and to identify possible solutions to the challenges that radiology could face in the future. We compared the annual amount of computed tomography (CT), radiography (X-ray), and ultrasound (US) examinations performed between the years 2010 and 2020 and analyzed the changes in the number of practicing radiologists in Poland. The mean number of patients treated in our hospital was 60,727 per year. During the last decade, the number of CT and US examinations nearly doubled (from 87.4 to 155.7 and from 52.1 to 86.5 per 1000 patients in 2010 and 2020 respectively), while X-ray examinations decreased from 115.1 to 96.9 per 1000 patients. The SARS-CoV-2 pandemic did not change the workload trends as more chest examinations were performed. AI, which contributed to the COVID-19 diagnosis, could aid radiologists in the future with the growing workload by increasing the efficiency of radiology departments as well as by potentially minimizing the related costs.

scholarly journals Chest X-Ray Findings Among Adult Patients Attending Usmanu Danfodiyo University Teaching Hospital Sokoto Northwestern Nigeria

2020 ◽  
Author(s):  
Mohammed Abacha ◽  
Isma'il Salima ◽  
Sadiq Abubakar Audu ◽  
Abubakar Umar ◽  
Gurama Aminu Dahiru ◽  
...  
Keyword(s):  
Teaching Hospital ◽  
Hypertensive Heart Disease ◽  
Adult Patients ◽  
University Teaching ◽  
Pathologic Finding ◽  
X Rays ◽  
X Ray ◽  
Number Of Patients ◽  
Male Preponderance ◽  
Chest X Ray

Background: Chest x-ray is the most frequently performed diagnostic examination particularly in patients with respiratory and cardiac diseases and for routine medical checkup and planning for surgery. A study on the image quality of chest x-rays had been conducted but the findings on the chest x-rays have not been studied in this tertiary health institution. This study aimed at revealing the most common pathologies and sex distribution of the pathologies on chest x-rays of adult patients attending the hospital. Materials and Methods: A retrospective study of 190 adult (aged 18 and above) patients’ chest x-ray reports was conducted using the existing reported documents of chest x-rays from the archives of Radiology Department of Usmanu Danfodiyo University Teaching Hospital (UDUTH) Sokoto from January 2018 - October 2019 using data capture sheet as instrument for data collection. Data was analyzed using Microsoft excel version 2010. Results: Out of the 190 chest x-rays, 54% were for male while 46% were for female patients with the highest number of patients in the 29-38 years age group. Most of the radiographs studied were normal examinations (38.95%). Moreover, the most common pathology was hypertensive heart failure (26.84%) with male preponderance (13.68%). Conclusion: Hypertensive heart disease is the most common pathologic finding of adult chest x-ray in the study area with elderly male preponderance.

scholarly journals SP9.1.3 Abdominal X-Rays in the Emergency Setting- A Review of Current Practice

2021 ◽  
Vol 108 (Supplement_7) ◽  
Author(s):  
Lará Armstrong ◽  
Helen Monaghan ◽  
Sarah Jeffers
Keyword(s):  
Diagnostic Imaging ◽  
Radiation Exposure ◽  
Diagnostic Yield ◽  
Hospital Costs ◽  
Radiology Department ◽  
Emergency Setting ◽  
X Rays ◽  
X Ray ◽  
Imaging Results ◽  
Patient Radiation Exposure

Abstract Aim Abdominal radiographs (AXRs) are commonly used in the setting of acute abdominal pain. However, with low diagnostic yield, they can increase workload within the radiology department, increase patient radiation exposure and ultimately delay further diagnostic imaging. The average cost of an abdominal film, excluding staffing costs, is £45. This study aimed to investigate the appropriate use of AXRs in the emergency setting, as per the Royal College of Radiologists Guidelines (RCR). Methods A single centre retrospective review was conducted of all patients referred to the emergency surgical team over a 21 day period. Data was retrieved from electronic handover records. Demographics, radiology request forms and imaging results were obtained from up to date electronic care records. Results A total of 160 patients presented within the audit window, with a median age 49 (16-94) and 61.3% male. Overall, 36.9% of patients underwent an abdominal x-ray, 66.1% of which were not indicated in accordance with RCR guidelines. 71.2% of patients who underwent an abdominal x-ray required further diagnostic imaging by means of CT or USS. Only 10.2% of AXRs provided diagnostic information. Total cost expenditure for inappropriate AXRs = £1,755, excluding staffing costs. Conclusions Approximately two thirds of AXRs performed did not comply with the published RCR guidelines. Adherence to RCR guidelines can reduce needless radiation exposure, hospital costs and delay to diagnosis. We plan to conduct a teaching session on the RCR guidelines alongside the development of information posters, and re-audit our results.

DISCUSSION

PEDIATRICS ◽  
1967 ◽  
Vol 40 (3) ◽  
pp. 525-526
Keyword(s):  
Los Angeles ◽  
Inpatient Care ◽  
X Rays ◽  
X Ray ◽  
Long Period ◽  
Number Of Patients ◽  
Finite Period ◽  
The One ◽  
Ambulatory Services ◽  
Leukemia In Children

Dr. Borges: What are the comparative costs of just technical determinations, blood counts, various types of tests, x-rays, technician's time, etc., when you have a comparable number of patients in the hospital and readily available compared to the same number of patients who come in at various times on an ambulatory basis? I think there may be increased cost in ambulatory care, but I have no idea of the magnitude. When the x-ray department can call for the patient at any time that day compared with the one that shows up at 10:15 and then, to extend that example to the availability of all the medical forces at one predictable time when the patient is there for only a finite period of time, I wonder whether there is any data that would allow us to compare the costs on those two bases? Dr. Hartmann: I believe Dr. Hammond has such information. Dr. Denman Hammond: We have some data on inpatient care but insufficient figures relative to ambulatory services. I am trying to recall some of the data we have analyzed over a long period of years from the Children's Hospital of Los Angeles having to do with the proportion of the course of leukemia a child spent in the hospital. Prior to 1953 when we had no cooperative programs nor much in the way of chemotherapy, the course of leukemia in children was rather short. The records up to 1953 indicate that about 30% of the course, from diagnosis to death, was spent as an inpatient in a hospital.

STUDY OF INFLAMMATORY MARKERS IN RELATION TO RADIOLOGICAL FINDINGS IN COVID 19

2021 ◽  
pp. 48-50
Author(s):  
Kalyanisri. Koneru ◽  
V M Kiran Ogirala ◽  
Kommavarapu. Kalyani Madhuri ◽  
Bokam. Bhanu Rekha
Keyword(s):  
Hospital Stay ◽  
Tertiary Care ◽  
P Value ◽  
Care Hospital ◽  
X Rays ◽  
X Ray ◽  
Duration Of Hospital Stay ◽  
Number Of Patients ◽  
Chest X Ray ◽  
Severity Of The Disease

BACKGROUND Currently, the Coronavirus disease 2019 (COVID-19) has become pandemic globally. Elevated inammatory markers are observed and are a common pathophysiological response to acute illness. Chest X-ray changes are also commonly seen in COVID -19 patients. The present study was undertaken to determine the relationship between inammatory markers to chest X-ray ndings in COVID-19 patients. METHODS This is a prospective observational study of COVID-19 patients admitted to tertiary care hospital from may 2020-November 2020. Comorbidities, inammatory markers, and Chest X ray were collected and analyzed. Correlations between radiological and inammatory markers were studied. AIMS & OBJECTIVES: Ÿ Correlation of inammatory markers to radiographic ndings and their outcome in COVID 19 patients Ÿ The outcome was studied in terms of: Ÿ Patients requiring oxygen/ NIVsupport Ÿ duration of hospital stay Ÿ Number of patients Recovered/death RESULTS: Ÿ Out of 500 patients studied, the mean age was 49.41 years, and (295)59% of patients were male,(205)41% were females. (455)91% patients discharged and (43)8.6% died. We found a positive correlation between inammatory markers and Chest X-ray ndings at the time of admission with a signicant statistical P-value. The inammatory markers CRP, ESR, D-Dimer & Sr.ferritin compared with the mode of ventilation(O2 & NIV, duration of hospital stay and outcome also showed signicant statistical P-value. CONCLUSIONS We conclude that in patients with raised inammatory markers there were increased abnormalities on Chest X-rays which required an increase in oxygen or NIVsupport. This can be a useful predictor of the severity of the disease and assessment of outcome.

scholarly journals Virtual arthroplasty follow-up: five-year data from a district general hospital

2020 ◽  
Vol 102 (3) ◽  
pp. 220-224 ◽  
Author(s):  
R Fisher ◽  
V Hamilton ◽  
S Reader ◽  
F Khatun ◽  
M Porteous
Keyword(s):  
Knee Arthroplasty ◽  
Revision Surgery ◽  
Oxford Knee Score ◽  
District General Hospital ◽  
Assessment Process ◽  
X Rays ◽  
X Ray ◽  
Number Of Patients ◽  
Hip And Knee Arthroplasty

Introduction Follow-up after hip and knee arthroplasty is advocated to identify asymptomatic loosening and improve patient satisfaction. There are, however, financial and time implications associated with regular clinic appointments. Assessment through virtual means has been suggested as an alternative. Materials and methods At the West Suffolk Hospital, following arthroplasty surgery of the lower limb, patients are followed-up via a questionnaire at one and five years postoperatively, then subsequently at five-yearly intervals. Patients are recalled based on the outcome of these assessments. Using a locally compiled data base we identified all patients reviewed between 2011 and 2015 using this virtual assessment process and examined their outcomes. Results During the five years of follow-up, 5,380 patients were eligible for assessment. Compliance varied from 77% follow up for hips and 83% for knees. Ten patients were recalled following total hip replacement, eight for x-ray changes and one for a poor satisfaction score. Five went on to undergo revision surgery. Some 56 recalls to clinic following knee arthroplasty were seen; 42 due to a poor Oxford Knee Score, 6 with associated x-ray abnormalities and 6 isolated abnormal x-rays. Five subsequently underwent revision surgery; 30 (54%) were discharged after initial review and 18 (32%) were referred to different subspecialties. As a result of the virtual review process, 4,219 clinic appointments were avoided, with no documented admissions as a result of a missed complication from virtual review. Discussion A virtual arthroplasty clinic significantly reduces the number of patients attending regular follow-up clinics, without compromising safe practice.

Sign in / Sign up

Export Citation Format

Share Document