5 EHR-based strategies to reduce CT turnaround times
Imaging experts are suggesting five potential electronic health record-based strategies to improve CT turnaround times in an emergency department.
EDs have seen escalating utilization of radiologic services driven by climbing case counts, increasing severity of illness, complex workups and rapidly improving technology. This has led to delays in the delivery of CT imaging with dangerous implications for patient care, researchers wrote Friday in JACR.
To address this, imaging leaders with Denver Health have developed a list of EHR strategies to help improve imaging turnaround times. Their work is paying off, cutting the time from exam order placement to initiation by about 47%, falling from 69 minutes down to 37.
“In this study, we describe electronic health record improvements to reduce the adult ED CT prescan interval by unburdening the CT technologists,” John McMenamy, MD, MBA, associate chair of Denver Health’s Department of Radiology, and co-authors wrote April 25. “Specifically, we hypothesized that by focusing on EHR improvements we would significantly reduce ED CT order-to-begin times and ED CT order-to-begin time variability.”
For their investigation, McMenamy and colleagues established an interdisciplinary team to analyze this issue, including radiologists, CT technologists, emergency physicians, and registered nurse leaders. They met monthly for an hour over a six-month period, with the goal of selecting the best interventions to implement. Their EHR improvements included:
1. Exam order pick lists: Organizing these lists based on clinical indication enables clinicians to more easily select the correct exam. This thereby reduces the number of incorrect orders that require technologists to contact the referrer, who must then cancel and resubmit the request.
2. Integrated screening policies: Incorporating kidney function, pregnancy and IV contrast reaction screening checks directly into the CT exam order. This eliminates common sources of delay stemming from confusion around the patient’s preparedness.
3. Technologist protocoling: Developing protocol instruction sheets with the help of department radiologists. These were provided to CT technologists, tasking them with serving as the primary party in charge of protocols. Doing so eliminated the need to wait for a radiologist to protocol an exam, or for a technologist to phone the rad to discuss the order.
4. CT technologist details tab: Creating an additional tab within the EHR, displaying details on whether the patient is prepared for the exam. The tab includes information on any requirements prior to CT such as IV contrast or lab results.
“By centralizing and clearly displaying the information on one tab within the EHR, CT technologists were able to quickly determine what patients were ready to scan, eliminating unnecessary delays and work trying to resolve confusion over incomplete or hard-to-find patient information,” the authors noted.
5. Banners for communication: Creating EHR communication broadcast banners to notify ED staff about the availability of dedicated radiology transporters for CT.
“By facilitating proactive communication between radiology and the ED, EHR broadcast communication banners eliminated confusion related to radiology transport availability, the associated delays, and CT technologist work required to communicate the status of radiology transport to all units and teams in the ED,” the research team advised.
McMenamy and co-authors analyzed data spanning 30 months or 62,540 total CT exams and covering both before and after the implementation of the five interventions. Median order-to-begin times decreased by about 16 minutes after tackling the first three changes in January 2021 and another 13 minutes after the last two were added in December of the same year. Along with cutting the span from order to exam completion by 47%, interquartile range variability dropped by 38%, “demonstrating the effectiveness of EHR improvements.”
“By eliminating errors, confusion, and unnecessary work, our five interventions reduced ED CT prescan order-to-begin variability creating a more reliable process for the clinical teams, technologists, and radiologists,” the authors wrote.
Read much more, including potential study limitations, in the Journal of the American College of Radiology.
Marty Stempniak has covered healthcare since 2012, with his byline appearing in the American Hospital Association's member magazine, Modern Healthcare and McKnight's. Prior to that, he wrote about village government and local business for his hometown newspaper in Oak Park, Illinois. He won a Peter Lisagor and Gold EXCEL awards in 2017 for his coverage of the opioid epidemic.