JACR: ED transfers result in unnecessary CT exams

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A large percentage of emergency department (ED) transfer patients undergo unnecessary CT exams as a result of the move from one ED to another, according to a study in this month's Journal of the American College of Radiology.

According to Jeffrey Sung, MD, from the department of radiology at Brigham and Women’s Hospital in Boston, and colleagues, CT imaging plays a crucial role in the diagnosis and treatment management of many ED patients, and those images are a frequent component in the information accompanying those patients when they are transferred.

Despite the important role imaging plays among ED transfer patients, the authors claimed that the management of outside imaging at the receiving hospitals is often “suboptimal.” This, the authors said, is due to the fact that CDs are the technology of choice for transferring images, and that the large variety of CD user interfaces and variable system requirements often make viewing of outside studies inefficient. “[T]he CD often passes transiently through the radiology reading room, is less accessible to treating physicians, and is at greater risk for loss,” the authors wrote.

Still, Sung and colleagues wrote, the review of outside imaging at receiving institutions is a “patient care imperative,” particularly since hospitals need to utilize their imaging resources efficiently and avoid repeated ionizing radiation exposure and the administration of contrast material associated with imaging.

The authors reviewed 425 CT studies for 255 transfer patients. The patients' mean age was 59 years, 57 percent were male, and the most common clinical indications were trauma and suspected intracranial hemorrhage.

Of the 425 outside hospital scans, 122 were repeated, for reasons including inadequate or incomplete imaging, IT issues, clinical need or a combination of the three reasons. The researchers said that 35 percent of repeat CT studies were performed for imaging or IT reasons “and thus may have been avoidable."

The authors concluded that better methods of transferring CT data to receiving facilities and improved communication of outside CT reports “could increase efficiency, mitigate errors and reduce the need for repeat imaging.”

For example, in the future, radiology departments should look into routinely importing outside studies into receiving institutions' PACS. “Or Institutions could improve the transfer of imaging data,” the authors suggested, “through uniform adoption of the [DICOM] format for interinstitutional image transfer, standardization of CD viewing software, or the development of central image repositories designed to facilitate multi-institutional access via a universal patient identifier.”