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 emergency department (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 (SNHs). Because of 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 EHR-based interventions were conceptualized and implemented by an interdisciplinary team of radiologists, CT technologists, ED physicians, and ED registered nurse leadership: examination order pick lists, integrated screening policies, technologist protocoling, CT Technologist Details tab, and banners for communication. A pre- and postintervention retrospective review was performed from January 1, 2021, through June 30, 2023. All CT examinations done on adults (≥18 years old), on either of the two hospital CTs, were included. Project periods were 6 months long and included preintervention, intervention, postintervention, and two additional sets of postintervention data: sustainment period 1 and sustainment period 2. Examination order and examination begin times were collected from the Epic EHR (Epic Systems, Madison, Wisconsin). Comparison of examination order-to-begin times pre- and postintervention were made using Wilcoxon’s rank-sum test analysis.

Results

In all, 62,540 CTs were performed during the 30 months of data collection: 11,499 preintervention, 12,475 intervention, 12,496 postintervention, 13,062 sustainment 1, and 13,008 sustainment 2. Median order-to-begin times decreased by 16 min after the implementation of the first three interventions in July 2021 and decreased by 13 min after the last two interventions in December 2021. Overall, the five selected interventions reduced ED CT prescan examination order-to-begin times by 46.6% (69 versus 37 min, P < .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.