Clinical Information Available During Emergency Department Imaging Order Entry and Radiologist Interpretation

Objective: The objective of this study was to evaluate the proportion of Emergency Department (ED) radiology examinations ordered or interpreted prior to a documented clinical assessment.

Materials And Methods: We collected 600 retrospective consecutive ED cases consisting equally of patients whose first ED imaging examination was computed tomography (CT), radiography (XR), or ultrasonography (US). For each patient, the following times were documented: ED arrival, ED departure, ED length of stay (LOS), imaging order entry, image availability, radiology report availability, triage note, ED provider note, and laboratory results.

Results: Mean age was 44.2, 66.5% female, and mean ED LOS was 326.2 min. ED LOS was longer for patients who received CT versus XR (343.9 vs. 311.3; p = 0.029). In 25.5% of XR, 10% of CT, and 8% of US cases, the imaging exam was completed before the ED provider note was started. In 20.5% of XR, 6.5% of CT, and 6% of US cases, the radiologist did not have the ED provider note available prior to completing their diagnostic interpretation. In 33.4% of all cases and 57.5% of XR cases, incomplete clinical documentation (triage note, provider note, lab results) was available during radiology report creation. CT and US exams more frequently had clinical data available prior to radiologist interpretation than XR (p < 0.0001). Radiologist turn-around-time was unaffected by clinical information availability.

Conclusion: Eight percent of ED CT and 10% of ED US examinations were ordered and completed before documented clinical assessment. Thirty-three percent had incomplete clinical assessment performed prior to image interpretation. Further investigation is needed to determine impact on interpretation accuracy.