Patient factors play key role in emergency department imaging

June 25, 2013, Radiological Society of North America

Despite concerns to the contrary, very little of the variation in Emergency Department (ED) imaging utilization is attributable to physician experience, training or gender, according to a new study published online in the journal Radiology.

Imaging exams like and CT scans are common in the ED. In 2010, slightly more than 47 percent of all ED visits in the United States had an imaging exam associated with them.

"Analyzing and understanding drivers of use of imaging in the ED is important for several reasons," said Christopher L. Sistrom, M.D., M.P.H., Ph.D., from the departments of radiology at Massachusetts General Hospital in Boston and the University of Florida in Gainesville, Fla. "There's a balance of cost and benefits to the patient, institution and payer, as well as the overarching issue of ."

Previous studies have found substantial variation in imaging rates across and within EDs, suggesting different tendencies among physicians when ordering imaging. However, much of the existing research is limited, according to Dr. Sistrom.

"A lot of literature on imaging variability can lead to a false assumption that doctors are primarily responsible," he said. "The problem is that it is difficult to fully describe and quantify variability at the different levels it can occur."

In the new study, Dr. Sistrom and colleagues analyzed 88,851 ED visits during 2011 at Massachusetts General Hospital. They used an analytical tool known as hierarchical to identify multiple predictors of the probability that imaging was ordered during a given visit.

"That's what makes our paper unique," Dr. Sistrom said. "Hierarchal modeling allows us to ask very specific questions about the relative contributions of various factors to imaging use."

The overall rate of imaging utilization in the Massachusetts General ED was 45.4 percent in 2011, similar to the 2010 national average of 47.2 percent. Analysis of the data revealed that physician-related factors like gender, experience and training did not correlate with imaging use.

"The key finding in our study is that doctors don't make much difference in imaging utilization," Dr. Sistrom said. "Our data showed that doctors are responsible for about one percent of the variability in probability of having an imaging exam during an ED visit."

Instead, patient and visit factors were the predominant predictors of the likelihood of imaging for a given ED visit. These factors include prior visit, referral source, arrival mode and clinical reason for the visit.

The workload of the ED was another significant factor in imaging use. When the ED was the least busy, the odds of low-cost imaging were 11 percent higher than the reference standard. A busier ED resulted in a tendency towards more high-cost imaging.

The new study shows that medical management efforts looking to reduce imaging utilization may be misguided in focusing on remediating ED physicians.

"To reduce imaging utilization, a lot of people in quality improvement and medical management might try to identify high outliers and punish them," Dr. Sistrom said. "In settings like the one we studied, that strategy won't get you anything but angry doctors."

Explore further: Diagnosis, treatment of common outpatient disorder adds $238 million a year in ER costs

More information: "Use of Imaging in the Emergency Department: Physicians Have Limited Effect on Variation." Radiology, 2013.

Related Stories

Diagnosis, treatment of common outpatient disorder adds $238 million a year in ER costs

May 5, 2013
A relatively common urinary tract disorder that can usually be managed in an outpatient setting is adding an estimated $238 million a year to the cost of emergency room visits in the U.S., according to two new studies from ...

More than 9-in-10 ED patients who receive CT of the abdomen and pelvis are clinically complex

June 1, 2012
The overwhelming majority (93.8 percent) of patients undergoing computed tomography (CT) of the abdomen and pelvis (CTAP) in the emergency department (ED) setting are classified as clinically complex, according to a study ...

Pilot program using telemedicine to decrease emergency room wait times

June 12, 2013
Emergency department (ED) overcrowding has been a major issue nationally for 20 years and continues to increase in severity. To address this issue, a pilot study has been launched at UC San Diego Health System's ED to use ...

Self-referral: A significant factor in imaging growth

July 1, 2011
A recent study in the Journal of the American College of Radiology suggests that self-referral in medical imaging may be a significant contributing factor in diagnostic imaging growth.

Knowing cost of imaging tests doesn't cut utilization

February 1, 2013
(HealthDay)—Physicians do not order fewer imaging tests if they are aware of the costs, according to a study published online Jan. 2 in the Journal of the American College of Radiology.

Recommended for you

Air pollution may shorten telomeres in newborns

January 24, 2018
A study conducted before and after the 2004 closure of a coal-burning power plant in Tongliang, China, found children born before the closure had shorter telomeres than those conceived and born after the plant stopped polluting ...

Number of older people with four or more diseases will double by 2035, say researchers

January 23, 2018
A study published today in Age and Ageing, the scientific journal of the British Geriatrics Society, reports that the number of older people diagnosed with four or more diseases will double between 2015 and 2035. A third ...

Placental accumulation of flame retardant chemical alters serotonin production in rats

January 22, 2018
A North Carolina State University-led research team has shown a connection between exposure to a widely used flame retardant chemical mixture and disruption of normal placental function in rats, leading to altered production ...

Marijuana use does not lower chances of getting pregnant

January 22, 2018
Marijuana use—by either men or women—does not appear to lower a couple's chances of getting pregnant, according to a new study led by Boston University School of Public Health (BUSPH) researchers.

Women run faster after taking newly developed supplement, study finds

January 19, 2018
A new study found that women who took a specially prepared blend of minerals and nutrients for a month saw their 3-mile run times drop by almost a minute.

Americans are getting more sleep

January 19, 2018
Although more than one in three Americans still don't get enough sleep, a new analysis shows first signs of success in the fight for more shut eye. According to data from 181,335 respondents aged 15 and older who participated ...

0 comments

Please sign in to add a comment. Registration is free, and takes less than a minute. Read more

Click here to reset your password.
Sign in to get notified via email when new comments are made.