Reducing emergency department return visits for ultrasound imaging: a quality improvement initiative.

Background: The shortage of after-hours ultrasound (US) imaging in the ED puts considerable strain on the patient and the already scant resources in the ED. Implementing an alternate clinical pathway that guides ED physicians to utilize the US imaging centers in the community for non-emergent scans may help alleviate some of these stressors. We aimed to reduce the number of patients returning to the ED for US by 50% within 6 months of implementation.

Methods: After performing a root cause analysis and creating a process map, a multidisciplinary team designed an alternate clinical pathway utilizing community radiology centers to perform Next Day US. Following the implementation of a new clinical pathway in January 2022, we performed an analysis of electronic health record data to assess the differences in the usage of next day US in the ED pre- (2019-21) and post-implementation (2022) of the new clinical pathway.

Results: The study screened for ED next day US usage in 123,386 patients who visited Saskatoon EDs between January and June 2019-2022. Post-implementation of the pathway in January 2022, there was a 48% decrease in the percentage of patients returning to the ED the next day for US. Run charts displayed non-random signal of change evidenced by a shift. There was no difference in the patient's length of stay (LOS) before and after pathway implementation.

Conclusions: Successful implementation of a new imaging pathway led to a significant decrease in the number of patients returning to the ED the next day for ultrasound.