Who explicitly requests the ordering of computed tomography for emergency department patients? A multicenter prospective study

Joshua Seth Broder, Rahul Bhat, Joshua P. Boyd, Ivan A. Ogloblin, Alexander Limkakeng, Michael Brian Hocker, Weiying Gao Drake, Taylor Miller, John Brian Harringa, Michael D. Repplinger

Research output: Contribution to journalArticle

2 Citations (Scopus)

Abstract

Emergency department (ED) computed tomography (CT) use has increased substantially in recent years, resulting in increased radiation exposure for patients. Few studies have assessed which parties contribute to CT ordering in the ED. The objective of this study was to determine the proportion of CT scans ordered due to explicit requests by various stakeholders in ED patient care. This is a prospective, observational study performed at three university hospital EDs. CT scans ordered during research assistant hours were eligible for inclusion. Attending emergency physicians (EPs) completed standardized data forms to indicate all parties who had explicitly requested that a specific CT be performed. Forms were completed before the CT results were known in order to minimize bias. Data were obtained from 77 EPs regarding 944 CTs. The parties most frequently requesting CTs were attending EPs (82.0 %, 95 % CI 79.4–84.3), resident physicians (28.6 %, 95 % CI 25.8–31.6), consulting physicians (24.4 %, 95 % CI 21.7–27.2), and admitting physicians (3.9 %, 95 % CI 2.9–5.4). In the 168 instances in which the attending EP did not explicitly request the CT, requests most commonly came from consulting physicians (51.2 %, 95 % CI 43.7–58.6), resident physicians in the ED (39.9 %, 95 % CI 32.8–47.4), and admitting physicians (8.9 %, 95 % CI 5.5–14.2). EPs were the sole party requesting CT in 46.2 % of cases while multiple parties were involved in 39.0 %. Patients, families, and radiologists were uncommon sources of such requests. Emergency physicians requested the majority of CTs, though nearly 20 % were actually not desired by them. Admitting, consulting, and resident physicians in the ED were important contributors to CT utilization.

Original languageEnglish (US)
Pages (from-to)221-227
Number of pages7
JournalEmergency Radiology
Volume23
Issue number3
DOIs
StatePublished - Jun 1 2016
Externally publishedYes

Fingerprint

Multicenter Studies
Hospital Emergency Service
Tomography
Prospective Studies
Physicians
Emergencies
Observational Studies
Patient Care

Keywords

  • Computed tomography
  • Decision support
  • Emergency department
  • Utilization

ASJC Scopus subject areas

  • Emergency Medicine
  • Radiology Nuclear Medicine and imaging

Cite this

Who explicitly requests the ordering of computed tomography for emergency department patients? A multicenter prospective study. / Broder, Joshua Seth; Bhat, Rahul; Boyd, Joshua P.; Ogloblin, Ivan A.; Limkakeng, Alexander; Hocker, Michael Brian; Drake, Weiying Gao; Miller, Taylor; Harringa, John Brian; Repplinger, Michael D.

In: Emergency Radiology, Vol. 23, No. 3, 01.06.2016, p. 221-227.

Research output: Contribution to journalArticle

Broder, JS, Bhat, R, Boyd, JP, Ogloblin, IA, Limkakeng, A, Hocker, MB, Drake, WG, Miller, T, Harringa, JB & Repplinger, MD 2016, 'Who explicitly requests the ordering of computed tomography for emergency department patients? A multicenter prospective study', Emergency Radiology, vol. 23, no. 3, pp. 221-227. https://doi.org/10.1007/s10140-016-1382-5
Broder, Joshua Seth ; Bhat, Rahul ; Boyd, Joshua P. ; Ogloblin, Ivan A. ; Limkakeng, Alexander ; Hocker, Michael Brian ; Drake, Weiying Gao ; Miller, Taylor ; Harringa, John Brian ; Repplinger, Michael D. / Who explicitly requests the ordering of computed tomography for emergency department patients? A multicenter prospective study. In: Emergency Radiology. 2016 ; Vol. 23, No. 3. pp. 221-227.
@article{0fb1876a89ed4386b4abf829f16a77b4,
title = "Who explicitly requests the ordering of computed tomography for emergency department patients? A multicenter prospective study",
abstract = "Emergency department (ED) computed tomography (CT) use has increased substantially in recent years, resulting in increased radiation exposure for patients. Few studies have assessed which parties contribute to CT ordering in the ED. The objective of this study was to determine the proportion of CT scans ordered due to explicit requests by various stakeholders in ED patient care. This is a prospective, observational study performed at three university hospital EDs. CT scans ordered during research assistant hours were eligible for inclusion. Attending emergency physicians (EPs) completed standardized data forms to indicate all parties who had explicitly requested that a specific CT be performed. Forms were completed before the CT results were known in order to minimize bias. Data were obtained from 77 EPs regarding 944 CTs. The parties most frequently requesting CTs were attending EPs (82.0 {\%}, 95 {\%} CI 79.4–84.3), resident physicians (28.6 {\%}, 95 {\%} CI 25.8–31.6), consulting physicians (24.4 {\%}, 95 {\%} CI 21.7–27.2), and admitting physicians (3.9 {\%}, 95 {\%} CI 2.9–5.4). In the 168 instances in which the attending EP did not explicitly request the CT, requests most commonly came from consulting physicians (51.2 {\%}, 95 {\%} CI 43.7–58.6), resident physicians in the ED (39.9 {\%}, 95 {\%} CI 32.8–47.4), and admitting physicians (8.9 {\%}, 95 {\%} CI 5.5–14.2). EPs were the sole party requesting CT in 46.2 {\%} of cases while multiple parties were involved in 39.0 {\%}. Patients, families, and radiologists were uncommon sources of such requests. Emergency physicians requested the majority of CTs, though nearly 20 {\%} were actually not desired by them. Admitting, consulting, and resident physicians in the ED were important contributors to CT utilization.",
keywords = "Computed tomography, Decision support, Emergency department, Utilization",
author = "Broder, {Joshua Seth} and Rahul Bhat and Boyd, {Joshua P.} and Ogloblin, {Ivan A.} and Alexander Limkakeng and Hocker, {Michael Brian} and Drake, {Weiying Gao} and Taylor Miller and Harringa, {John Brian} and Repplinger, {Michael D.}",
year = "2016",
month = "6",
day = "1",
doi = "10.1007/s10140-016-1382-5",
language = "English (US)",
volume = "23",
pages = "221--227",
journal = "Emergency Radiology",
issn = "1070-3004",
publisher = "Springer New York",
number = "3",

}

TY - JOUR

T1 - Who explicitly requests the ordering of computed tomography for emergency department patients? A multicenter prospective study

AU - Broder, Joshua Seth

AU - Bhat, Rahul

AU - Boyd, Joshua P.

AU - Ogloblin, Ivan A.

AU - Limkakeng, Alexander

AU - Hocker, Michael Brian

AU - Drake, Weiying Gao

AU - Miller, Taylor

AU - Harringa, John Brian

AU - Repplinger, Michael D.

PY - 2016/6/1

Y1 - 2016/6/1

N2 - Emergency department (ED) computed tomography (CT) use has increased substantially in recent years, resulting in increased radiation exposure for patients. Few studies have assessed which parties contribute to CT ordering in the ED. The objective of this study was to determine the proportion of CT scans ordered due to explicit requests by various stakeholders in ED patient care. This is a prospective, observational study performed at three university hospital EDs. CT scans ordered during research assistant hours were eligible for inclusion. Attending emergency physicians (EPs) completed standardized data forms to indicate all parties who had explicitly requested that a specific CT be performed. Forms were completed before the CT results were known in order to minimize bias. Data were obtained from 77 EPs regarding 944 CTs. The parties most frequently requesting CTs were attending EPs (82.0 %, 95 % CI 79.4–84.3), resident physicians (28.6 %, 95 % CI 25.8–31.6), consulting physicians (24.4 %, 95 % CI 21.7–27.2), and admitting physicians (3.9 %, 95 % CI 2.9–5.4). In the 168 instances in which the attending EP did not explicitly request the CT, requests most commonly came from consulting physicians (51.2 %, 95 % CI 43.7–58.6), resident physicians in the ED (39.9 %, 95 % CI 32.8–47.4), and admitting physicians (8.9 %, 95 % CI 5.5–14.2). EPs were the sole party requesting CT in 46.2 % of cases while multiple parties were involved in 39.0 %. Patients, families, and radiologists were uncommon sources of such requests. Emergency physicians requested the majority of CTs, though nearly 20 % were actually not desired by them. Admitting, consulting, and resident physicians in the ED were important contributors to CT utilization.

AB - Emergency department (ED) computed tomography (CT) use has increased substantially in recent years, resulting in increased radiation exposure for patients. Few studies have assessed which parties contribute to CT ordering in the ED. The objective of this study was to determine the proportion of CT scans ordered due to explicit requests by various stakeholders in ED patient care. This is a prospective, observational study performed at three university hospital EDs. CT scans ordered during research assistant hours were eligible for inclusion. Attending emergency physicians (EPs) completed standardized data forms to indicate all parties who had explicitly requested that a specific CT be performed. Forms were completed before the CT results were known in order to minimize bias. Data were obtained from 77 EPs regarding 944 CTs. The parties most frequently requesting CTs were attending EPs (82.0 %, 95 % CI 79.4–84.3), resident physicians (28.6 %, 95 % CI 25.8–31.6), consulting physicians (24.4 %, 95 % CI 21.7–27.2), and admitting physicians (3.9 %, 95 % CI 2.9–5.4). In the 168 instances in which the attending EP did not explicitly request the CT, requests most commonly came from consulting physicians (51.2 %, 95 % CI 43.7–58.6), resident physicians in the ED (39.9 %, 95 % CI 32.8–47.4), and admitting physicians (8.9 %, 95 % CI 5.5–14.2). EPs were the sole party requesting CT in 46.2 % of cases while multiple parties were involved in 39.0 %. Patients, families, and radiologists were uncommon sources of such requests. Emergency physicians requested the majority of CTs, though nearly 20 % were actually not desired by them. Admitting, consulting, and resident physicians in the ED were important contributors to CT utilization.

KW - Computed tomography

KW - Decision support

KW - Emergency department

KW - Utilization

UR - http://www.scopus.com/inward/record.url?scp=84957937513&partnerID=8YFLogxK

UR - http://www.scopus.com/inward/citedby.url?scp=84957937513&partnerID=8YFLogxK

U2 - 10.1007/s10140-016-1382-5

DO - 10.1007/s10140-016-1382-5

M3 - Article

C2 - 26873604

AN - SCOPUS:84957937513

VL - 23

SP - 221

EP - 227

JO - Emergency Radiology

JF - Emergency Radiology

SN - 1070-3004

IS - 3

ER -