Medical Research: What is the background for this study? What are the main findings?
Dr. Kielar: One of the goals of imaging is to provide homogeneous and consistent, high-quality care for patients using available equipment. In our hospital system, we had two separate hospitals that merged to form one teaching centre over 15 years ago. Most processes and protocols are same between the two hospital sites as a result of having the same administration and the same University affiliation. Also, the same residents and staff rotate through the emergency departments and radiology departments at both hospitals. One variable that persists is the location of the CT scanner. At one center a space was created to place a CT scanner in the Emergency Department. At the other site, the CT scanner is in the radiology department. For non-trauma cases, we wanted to see if the difference in distance of the scanner with respect to the emergency department location, has a role in the time required to obtain CT scan from the time it is requested ,as well as the time to final patient disposition. We defined final patient disposition to include admission, subspecialty consultation or discharge home.
Medical Research: What are the main findings?
Dr. Kielar: We found that there was a statistically significant difference in the time between requested CT and time to completion of the CT between the two hospital sites. It was faster when the CT scanner was located in the emergency department. This was in the range of 16 minutes ,which is longer than simply the time required to walk over (and back) to the the CT scanner from the emergency department.
We also found a statistically significant difference in the time of the final patient disposition. Of note, there was no statistically significant difference noted in the time to obtain a CT scan as well as the preliminary radiology interpretation for patients with hyperacute conditions such as suspected abdominal aortic aneurysm rupture, regardless of the location of the CT scanner with respect to the ED.
Medical Research: What should clinicians and patients take away from your report?
Dr. Kielar: When planning a new emergency department, or undertaking renovations of an existing facility, consideration should be made for placing a CT scanner in the ED in order to increase efficiency of patient throughput and care.
Medical Research: What recommendations do you have for future research as a result of this study?
Dr. Kielar: Further research into differences in utilization of the CT scanner, when a CT scanner is more or less easily accessible, would be of value. Specifically adherence of emergency physicians to current imaging guidelines when a CT scanner is easily available in the Emergency department should be evaluated.
Research into potential resulting differences in patient care, including rate of patient admission, rate of return to the ED and quality of life related to access to ED CT may be of value.
Finally, the quality of a provided history and the effect of this history on the type of imaging performed and accuracy of the imaging report may be another venue for future research in this field.
Does distance matter? Effect of having a dedicated CT scanner in the emergency department on completion of CT imaging and final patient disposition times
Wilfred Dang, BHS, Ania Z. Kielar, MD, FRCPC , Angel YN. Fu, BMS
Suzanne T. Chong, MD, MS,