Inefficient Resource Use for Patients Who Receive Both a Chest Radiograph and Chest CT in a Single Emergency Department Visit

Purpose: The goal of this study was to examine emergency department (ED) ordering practices in patients receiving both chest radiography (CXR) and chest CT (CCT).

Methods: Consecutive ED patients receiving both CXR and CCT in a single ED visit from January 2009 to December 2013 were included. For each examination, the time of order entry, time of study completion, and time of final interpretation were recorded and analyzed.

Results: A total of 3,627 patients met the inclusion criteria. In 3,437 (94.8%) patients, the CXR was ordered first; in 43 (1.2%), the CCT was ordered first; and in 91 (2.5%), the CCT and CXR were ordered simultaneously. In 50.3% (1,826 of 3,627) of all cases, imaging in the second modality (whether CCT or CXR) was ordered before final report availability of the first exam. In 9.8% (n = 354 of 3,627) of all cases, imaging in the second modality (whether CCT or CXR) was ordered before image availability from the first examination.

Conclusions: These results suggest inefficient resource usage, for which targeted technology solutions may be helpful.