Multisystem factors contributing to redundant intracranial vascular imaging in the ED.

Publisher: Springer-Verlag New York Inc Country of Publication: United States NLM ID: 9431227 Publication Model: Print-Electronic Cited Medium: Internet ISSN: 1438-1435 (Electronic) Linking ISSN: 10703004 NLM ISO Abbreviation: Emerg Radiol Subsets: MEDLINE

Publication: New York, NY : Springer-Verlag New York Inc
Original Publication: Baltimore, MD. : Williams & Wilkins, c1994-

Emergency Service, Hospital* ; Computed Tomography Angiography*/methods ; Magnetic Resonance Angiography*/methods; Humans ; Retrospective Studies ; Male ; Female ; Middle Aged ; Adult ; Aged ; Unnecessary Procedures ; Length of Stay/statistics & numerical data ; Cerebral Angiography

Purpose: To evaluate the multisystem factors contributing to redundant neurovascular orders in the ED.
Methods: This was an IRB-approved, retrospective study, performed at a single institution examining a 5-year history of redundant CTA/MRA head and neck (HN) exams performed in the ED for patients with no documented clinical change in mental status/neurological exam necessitating additional imaging. Factors contributing to redundant ordering including provider experience, synchronous order placement, and radiologist recommendations were examined. Additionally, the impact of duplicative imaging in terms of medical cost and ED length of stay was evaluated.
Results: 250 patients met inclusion criteria with both CTA/MRA of the HN performed during a single ED encounter (total 500 exams). 190 (76%) redundant exams were not recommended by a radiologist and contributed to an added ED length of stay of 3.6 h on average. Provider experience was not a significant contributing factor. 60 (24%) of redundant exams were recommended by a radiologist and were most frequently CTAs needed to clarify an area of artifact/high-grade stenosis/occlusion on a primary MRA exam.
Conclusion: Evaluation of contributing factors to redundant CTA/MRA HN exams ordering has highlighted multiple associated factors including provider experience, recommendations by radiologists for clarification of MRA findings, as well as systems processes related to synchronous CTA/MRA order placement.
(© 2024. The Author(s), under exclusive licence to American Society of Emergency Radiology (ASER).)

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Keywords: CT angiography; Emergency radiology; MR angiography; Neuroradiology

Date Created: 20240520 Date Completed: 20240730 Latest Revision: 20240730

20240730

10.1007/s10140-024-02240-2

38769220