The emergency department (ED) at Rhode Island Hospital is essentially a hospital within a hospital. Rhode Island Hospital’s ED is one of the largest emergency departments in the country with more than 101,000 visits per year. Our Andrew F. Anderson Emergency Center, which is a Level I trauma center, is equipped with five x-ray units within the five trauma rooms. Three additional x-ray units, two ultrasound rooms, two 64-slice CT scanners and a new MRI unit complete the imaging resources.
We perform 380,000 imaging studies per year in the diagnostic imaging department; one-third of our volume comes from the ED patients. Over the past several years, we have come to realize that critical diagnoses and treatment could be delayed because we lacked the ability to do an MRI promptly.
The three MRI units within our hospital are sited a considerable distance from the ED, and it could be difficult to move unstable patients to this environment through often busy hallways. It also was difficult to secure emergency department slots on these scanners, which often has a very busy schedule.
With this need unfulfilled, the leadership of the emergency department and diagnostic imaging elected to carve out space within the ED where we could place an MRI unit and operate it 24/7 in an effort to meet the critical and time-sensitive needs of many ED patients. We have developed “limited” protocols in the ED so that patients can have a very specific answer with only 10 to 15 minutes of scanner time. In fact, stroke, epidural and fracture protocols all take less than 15 minutes.
Diagnostic imaging and the multitude of different cross-sectional techniques complement and augment the physical exam and clinical history. With the addition of MR, any diagnostic imaging test that a patient needs while in our emergency department—x-ray, ultrasound, CT scan, MRI—can be performed in the ER. Prompt diagnosis facilitated with immediate MRI allows patient care to begin immediately.
In the several weeks we have had our MRI running, we have certainly facilitated care and shortened the time to diagnosis. ED patients are provided the highest level of service and the profile of the ED as a technological focus is recognized by the referring physicians and patients.
About the author: John Cronan, MD, is chief of the department of diagnostic imaging at Rhode Island Hospital.