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.
","language":null,"license":{"name":"Creative Commons Attribution 4.0","short_name":"CC BY 4.0","text":"Attribution — You must give appropriate credit, provide a link to the license, and indicate if changes were made. You may do so in any reasonable manner, but not in any way that suggests the licensor endorses you or your use.\r\n\r\nNo additional restrictions — You may not apply legal terms or technological measures that legally restrict others from doing anything the license permits.","url":"https://creativecommons.org/licenses/by/4.0"},"keywords":[{"word":"emergency department"},{"word":"computed tomography"},{"word":"CT"},{"word":"Outlier analysis"},{"word":"Significant delay"}],"section":"Emergency Department Operations","is_remote":true,"remote_url":"https://escholarship.org/uc/item/19j7199s","frozenauthors":[{"first_name":"Arjun","middle_name":"","last_name":"Dhanik","name_suffix":"","institution":"Beth Israel Deaconess Medical Center, Department of Emergency Medicine, Boston, Massachusetts; Harvard Medical School, Harvard University, Boston, Massachusetts","department":"None"},{"first_name":"Bryan","middle_name":"A.","last_name":"Stenson","name_suffix":"","institution":"Beth Israel Deaconess Medical Center, Department of Emergency Medicine, Boston, Massachusetts; Harvard Medical School, Harvard University, Boston, Massachusetts","department":"None"},{"first_name":"Robin","middle_name":"B.","last_name":"Levenson","name_suffix":"","institution":"Beth Israel Deaconess Medical Center, Department of Emergency Medicine, Boston, Massachusetts; Harvard Medical School, Harvard University, Boston, Massachusetts","department":"None"},{"first_name":"Peter","middle_name":"S.","last_name":"Antkowiak","name_suffix":"","institution":"Beth Israel Deaconess Medical Center, Department of Emergency Medicine, Boston, Massachusetts; Harvard Medical School, Harvard University, Boston, Massachusetts","department":"None"},{"first_name":"Leon","middle_name":"D.","last_name":"Sanchez","name_suffix":"","institution":"Harvard Medical School, Harvard University, Boston, Massachusetts; Brigham and Women’s Faulkner Hospital, Department of Emergency Medicine, Boston, Massachusetts","department":"None"},{"first_name":"David","middle_name":"T.","last_name":"Chiu","name_suffix":"","institution":"Beth Israel Deaconess Medical Center, Department of Emergency Medicine, Boston, Massachusetts; Harvard Medical School, Harvard University, Boston, Massachusetts","department":"None"}],"date_submitted":"2023-01-24T09:39:40+03:00","date_accepted":"2023-01-24T09:39:40+03:00","date_published":"2024-02-09T17:00:00+03:00","render_galley":{"label":"PDF","type":"pdf","path":"https://journalpub.escholarship.org/westjem/article/17831/galley/9608/download/"},"galleys":[{"label":"PDF","type":"pdf","path":"https://journalpub.escholarship.org/westjem/article/17831/galley/9608/download/"}]}