How Are Patient Order and Shift Timing Associated with Imaging Choices in the Emergency Department? Evidence From Niagara Health Administrative Data - 18/10/22
, Sabreena Moosa, BSc (Hons.), MD (cand.) c, Karyssa Hamann, BA, MD cAbstract |
Study objective |
We assessed whether the timing and order of patients over emergency shifts are associated with receiving diagnostic imaging in the emergency department and characterized whether changes in imaging are associated with changes in patients returning to the ED.
Methods |
In this retrospective study, we used multivariate and instrumental variable regressions to examine how the timing and order of patients are associated with the use of diagnostic imaging. Outcomes include whether a patient receives a radiograph, a computed tomography (CT) scan, an ultrasound, and 7-day bouncebacks to the ED. The variables of interest are time and order during a physician’s shift in which a patient is seen.
Results |
A total of 841,683 ED visits were examined from an administrative database of all ED visits to Niagara Health. Relative to the first patient, the probability of receiving a radiograph, CT, and ultrasound decreases by 6.4%, 9.1%, and 3.8% if a patient is the 15th patient seen during a shift. Relative to the first minute, the probability of receiving a radiograph, CT, or ultrasound increases by 1.9%, 2.7%, and 1.1% if a patient is seen in the 180th minute. Seven-day bounceback rates are not consistently associated with patient order or timing in a shift and imaging orders.
Conclusion |
Imaging in the ED is associated with shift length and especially patient order, suggesting that physicians make different imaging decisions over the course of their shifts. Additional imaging does not translate into reductions in subsequent bouncebacks to the hospital.
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| Please see page 393 for the Editor’s Capsule Summary of this article. |
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| Supervising editor: Daniel A. Handel, MD, MBA. Specific detailed information about possible conflicts of interest for individual editors is available at editors. |
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| Author contributions: SS contributed to the data analysis, conception, and writing of the manuscript. KH and SM contributed to the conception and writing of the manuscript. SS takes responsibility for the paper as a whole. |
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| All authors attest to meeting the four ICMJE.org authorship criteria: (1) Substantial contributions to the conception or design of the work; or the acquisition, analysis, or interpretation of data for the work; AND (2) Drafting the work or revising it critically for important intellectual content; AND (3) Final approval of the version to be published; AND (4) Agreement to be accountable for all aspects of the work in ensuring that questions related to the accuracy or integrity of any part of the work are appropriately investigated and resolved. |
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| Funding and support: By Annals policy, all authors are required to disclose any and all commercial, financial, and other relationships in any way related to the subject of this article as per ICMJE conflict of interest guidelines (see www.icmje.org/). The authors have stated that no such relationships exist. The authors report this article did not receive any outside funding or support. |
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Vol 80 - N° 5
P. 392-400 - novembre 2022 Retour au numéro
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