Electronic Health Record Improvements to Reduce Emergency Department CT Prescan Times at a Safety Net Hospital.

Abstract

Introduction: CT is a cornerstone of radiologic imaging in the ED and its utilization has increased over time. CT turnaround times remain a frequent focus for improvement initiatives, especially in resource-limited safety net hospitals (SNH). Due to the critical nature of CT imaging in the care of acutely ill ED patients and significant resource limitations SNHs face, SNHs must focus on process improvements, ideally that unburden their technologists, over additional resources to meet increasing volumes and rising expectations. In this study, we describe electronic health record (EHR) improvements to reduce the adult ED CT prescan interval by unburdening the CT technologists. 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.

Methods: Five EMR-based interventions were conceptualized and implemented by an interdisciplinary team of radiologists, CT technologists, ED physicians, and ED RN leadership: exam order pick lists, integrated screening policies, technologist protocoling, CT technologist details tab, and banners for communication. A pre- and post-intervention retrospective review was performed from January 1^st, 2021, through June 30^th, 2023. All CT exams done on adults (≥18 years old), on either of the two hospital CTs were included. Project periods were 6 months long and included pre-intervention, intervention, post-intervention, and two additional sets of post-intervention data: sustainment period 1 and sustainment period 2. Exam order and exam begin times were collected from the Epic EHR. Comparison of exam order-to-begin times pre- and post-intervention were made using Wilcoxon Rank Sum Test analysis.

Results: 62,540 CT were performed during the 30 months of data collection: 11,499 pre-intervention, 12,475 intervention, 12,496 post-intervention, 13,062 sustainment 1, and 13,008 sustainment 2.Median order-to-begin times decreased by 16 minutes after the implementation of the first three interventions in July 2021 and decreased by 13 minutes after the last two interventions in December 2021.Overall, thefiveselected interventions reduced ED CT prescan exam order-to-begin times by 46.6% (69 vs. 37 minutes, P <0.001) and interquartile range variability by 38.0%, demonstrating the effectiveness of EHR improvements.

Discussion: EHR improvements were effective in reducing ET CT prescan times and variability by unburdening CT technologist and improving ED CT performance.