Rising volumes in the ED: Radiology’s vital role in managing the crisis

Emergency departments (EDs) are busier than ever, and ED imaging volumes are up almost across the board.

According to research from the American Hospital Association, ED visits in the United States jumped from 92.6 million in 1993 to 133.6 million in 2013, and the country lost more than 500 EDs in that same timeframe creating the circumstances for a perfect storm in the nation’s EDs.

A 2016 Bank of America/Merrill Lynch Health Care Facilities Industry Overview noted that 67 percent of hospitals reported an increase in ED volume in February 2016 compared to the previous year. ED volume increased by an average of 4.8 percent year over year.

“Historically, median ER volumes have trended in the 1-3 percent range,” the report read. “After seeing a record +5.0 percent median increase in December 2015, the +4.0 percent median increase in February 2016 came in at the high end of the expected range.”

As one might expect, escalating ED volume has led to an increase in ED imaging. According to research from Thomas Jefferson University ED imaging utilization for x-ray and CT jumped dramatically from 2002 to 2012. There also were clear increases in the utilization of ultrasound and MRI/nuclear medicine, though they were not as significant.

Benefits of ED imaging

There is a tendency to view these statistics in a negative light, especially considering the way more and more providers are starting to focus on the cost of imaging and reducing exams that may be viewed as unnecessary.  However, increases in ED imaging have been shown to benefit both patients and referring physicians. 

For example, in a study by Pandharipande et al published in the March edition of the journal Radiology, researchers found that CT exams ordered in the ED had a positive impact on physicians’ diagnoses, admission decisions and diagnostic confidence.

According to the study, which included 245 physicians and more than 1,200 patients, a CT exam resulted in the leading diagnosis being changed in 51 percent of patients with abdominal pain, 42 percent of patients with chest pain and/or dyspnea and 24 percent of patients with headaches. Also, CT helped physicians either confirm or exclude at least 95 percent of their alternative diagnoses.

“Our results indicate that, in emergency department settings, physicians frequently make different diagnoses and decisions for their patients after CT and that diagnostic uncertainty is alleviated,” the authors wrote.

Increases in ED imaging volume also may be contributing to enhanced profitability for health systems. When Nashville, Tenn.-based HCA Holdings announced that revenue was up 6 percent for the first quarter of 2016, for example, it reported increases in admissions (1.8 percent), equivalent admissions (3.7 percent), and emergency room visits (7.6 percent).

The radiologist’s perspective

Sruti Nataraja, MPH, managing director of the Imaging Performance Partnership at the Advisory Board Company, recently examined rising ED volumes from an imaging perspective for a webinar, “ED Imaging Volume is Up: Understand the Trend and How Teams are Coping,” sponsored by vRad.

She reported that demand has pushed EDs “to a breaking point” and that care team members in the ED have learned to rely on imaging at a time when they feel overwhelmed or over-extended.

Nataraja also emphasized the importance of radiologists working toward improving turnaround times. “Think about radiology’s opportunity to help with perfecting ordering and utilization, optimizing capacity and streamlining patient prep,”  Nataraja said. “Ulimately, improving efficiency in the ED requires an all-hands-on-deck approach, with thoughtful collaboration between radiology and ED leadership.”

To watch a recording of the webinar, click: ED Imaging Volume is Up: Understand the Trend and How Teams are Coping.