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Song M, Ware RS, Doan TN, Harley D. Characteristics associated with frequent health system use by Australian adults with intellectual disability: A cohort study. JOURNAL OF APPLIED RESEARCH IN INTELLECTUAL DISABILITIES 2022; 35:1403-1417. [DOI: 10.1111/jar.13029] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/28/2021] [Revised: 02/23/2022] [Accepted: 07/20/2022] [Indexed: 11/28/2022]
Affiliation(s)
- Menghuan Song
- Queensland Centre for Intellectual and Developmental Disability (QCIDD) Mater Research Institute‐University of Queensland (MRI‐UQ) South Brisbane Queensland Australia
| | - Robert S. Ware
- Queensland Centre for Intellectual and Developmental Disability (QCIDD) Mater Research Institute‐University of Queensland (MRI‐UQ) South Brisbane Queensland Australia
- Menzies Health Institute Queensland Griffith University Nathan Queensland Australia
| | - Tan N. Doan
- Department of Medicine at The Royal Melbourne Hospital University of Melbourne Melbourne Victoria Australia
| | - David Harley
- Centre for Clinical Research University of Queensland South Brisbane Queensland Australia
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The Impact of the COVID-19 Pandemic on Medical Imaging Case Volumes in Aseer Region: A Retrospective Study. MEDICINES 2021; 8:medicines8110070. [PMID: 34822367 PMCID: PMC8622168 DOI: 10.3390/medicines8110070] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 10/31/2021] [Revised: 11/08/2021] [Accepted: 11/09/2021] [Indexed: 11/25/2022]
Abstract
COVID-19 has had a significant impact on global health systems. The aim of this study was to evaluate how imaging volumes and imaging types in radiology departments have been affected by the COVID-19 pandemic across different locations. Methods: Imaging volumes in the Aseer region (in the south of Saudi Arabia) across main hospitals were reviewed retrospectively including all cases referred from different locations (outpatient, inpatient and emergency departments). Data for years 2019 and 2020 were compared. The mean monthly cases were compared using a t-test. Results: The total imaging volumes in 2019 were 205,805 compared to 159,107 in 2020 with a 22.7% overall reduction. A substantial decline was observed in both the April to June and the July to September periods of approximately 42.9% and 44.4%, respectively. With respect to location, between April and June, the greatest decline was observed in outpatient departments (76% decline), followed by emergency departments (25% decline), and the least impact was observed in inpatient departments, with only 6.8% decline over the same period. According to modality type, the greatest decreases were reported in nuclear medicine, ultrasound, MRI, and mammography, by 100%, 76%, 74%, and 66%, respectively. Our results show a statistically significant (p-value ≤ 0.05) decrease of cases in 2020 compared to 2019, except for mammography procedures. Conclusion: There has been a significant decline in radiology volumes due to COVID-19. The overall reduction in radiology volumes was dependent on the stage/period of lockdown, location, and imaging modality.
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Rachh P, Pendley AM, Duong PAT, Hanna TN, Heilbrun ME. Decreasing CT Acquisition Time in the Emergency Department through Lean Management Principles. Radiographics 2021; 41:E81-E89. [PMID: 33939543 DOI: 10.1148/rg.2021200107] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Abstract
Background Emergency departments (EDs) rely on advanced imaging such as CT for diagnosis. Owing to increased ED volumes at the authors' institution, CT image acquisition became a significant bottleneck in ED patient throughput. Methods A multidisciplinary team was formed to solve this complex patient flow issue. Lean management principles were leveraged to identify process gaps and institute changes to achieve workflow improvements, remove process wastes, and improve patient throughput in the ED CT scanner. Process metrics such as percentage of CT examinations completed within 120 minutes and monthly median examination turnaround time (TAT) were tracked on a monthly basis. To measure impact, outcome metrics such as time savings from elimination of wasted steps were developed. Interventions Four projects including development of an ideal staffing model, a patient flow worksheet, revision of the CT patient screening form, and examination prioritization efforts were tested. Just-do-it activities such as revision of the CT angiography protocol ordering tool, optimizing scanner utilization, and improving communication and collaboration between the radiology department and ED were also attempted. Results After a phased rollout of changes over 6 months, the percentage of ordered ED CT examinations completed within 120 minutes increased by 10% (61%-71%); however, this improvement was sustained for only 6 weeks. Elimination of process inefficiencies resulted in a monthly median TAT reduction from 90-109 minutes to 82-106 minutes, and approximately 6 weeks (268 hours) of annualized full-time technologist time was saved. Conclusion Lean management tools can be leveraged to solve complex ED CT patient flow issues and reduce TAT. Online supplemental material is available for this article. ©RSNA, 2021.
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Affiliation(s)
- Pratik Rachh
- From the Departments of Radiology and Imaging Sciences (P.R., T.N.H., M.E.H.) and Emergency Medicine (A.M.P.), Emory Healthcare, 1364 Clifton Rd NE, Atlanta, GA 30322-1007; and Department of Radiology and Imaging Sciences, University of Utah Hospital, Salt Lake City, Utah (P.A.T.D.)
| | - Andrew M Pendley
- From the Departments of Radiology and Imaging Sciences (P.R., T.N.H., M.E.H.) and Emergency Medicine (A.M.P.), Emory Healthcare, 1364 Clifton Rd NE, Atlanta, GA 30322-1007; and Department of Radiology and Imaging Sciences, University of Utah Hospital, Salt Lake City, Utah (P.A.T.D.)
| | - Phuong-Anh T Duong
- From the Departments of Radiology and Imaging Sciences (P.R., T.N.H., M.E.H.) and Emergency Medicine (A.M.P.), Emory Healthcare, 1364 Clifton Rd NE, Atlanta, GA 30322-1007; and Department of Radiology and Imaging Sciences, University of Utah Hospital, Salt Lake City, Utah (P.A.T.D.)
| | - Tarek N Hanna
- From the Departments of Radiology and Imaging Sciences (P.R., T.N.H., M.E.H.) and Emergency Medicine (A.M.P.), Emory Healthcare, 1364 Clifton Rd NE, Atlanta, GA 30322-1007; and Department of Radiology and Imaging Sciences, University of Utah Hospital, Salt Lake City, Utah (P.A.T.D.)
| | - Marta E Heilbrun
- From the Departments of Radiology and Imaging Sciences (P.R., T.N.H., M.E.H.) and Emergency Medicine (A.M.P.), Emory Healthcare, 1364 Clifton Rd NE, Atlanta, GA 30322-1007; and Department of Radiology and Imaging Sciences, University of Utah Hospital, Salt Lake City, Utah (P.A.T.D.)
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Longitudinal Analysis of Neurodiagnostic Testing Utilization in Emergency Department Patients Presenting With Seizures or Epilepsy. J Am Coll Radiol 2021; 18:344-353. [DOI: 10.1016/j.jacr.2020.03.037] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/10/2020] [Revised: 03/05/2020] [Accepted: 03/06/2020] [Indexed: 11/19/2022]
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Vingiani V, Abadia AF, Posa A, Corvino A, Pasqualetto L, Presidente A, Losco M, Gray HN, Schoepf UJ. How the Workload and Outcome of Imaging Examinations Changed During the COVID-19 Pandemic Lockdown. ACTA BIO-MEDICA : ATENEI PARMENSIS 2020; 91:e2020166. [PMID: 33525213 PMCID: PMC7927480 DOI: 10.23750/abm.v91i4.10604] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 09/07/2020] [Accepted: 10/26/2020] [Indexed: 12/28/2022]
Abstract
Background: On March 9th, 2020, the Italian government decided to go into lockdown due to the COVID-19 pandemic, which led to changes in the workflow of radiological examinations. Aims: Aim of the study is to illustrate how the workload and outcome of radiological exams changed in a community hospital during the pandemic. Methods and Material: The exams performed in the radiology department from March 9th to March 29th, 2020 were retrospectively reviewed and compared to the exams conducted during the same time-period in 2019. Only exams coming from the emergency department (ED) were included. Two radiologists defined the cases as positive or negative findings, based on independent blind readings of the imaging studies. Categorical measurements are presented as frequency and percentages, and p-values are calculated using the Chi-squared test. Results and Conclusions: There was a significant reduction in the amount of exams performed in 2020: there were 143 (93|65% male, 60.7±21.5 years) patients who underwent radiological examinations from the ED vs. 485 (255|53% male, 51.2±24.8 years) in 2019. Furthermore, the total number of ED exams dropped from 699 (2019) to 215 (2020). However, the percentage of patients with a positive result was significantly higher in 2020 (69|48%) compared to 2019 (151|31%) (p<.001). The reduction of emergency radiological examinations might be a result of the movement restrictions enforced during the lockdown, and possible fear of the hospital as a contagious place. This translated to a relative increase of positive cases as only patients with very serious conditions were accessing the ED. (www.actabiomedica.it)
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Affiliation(s)
- Vincenzo Vingiani
- U.O.C. Radiologia, P.O. Sorrento, Ospedali riuniti "Area penisola Sorrentina".
| | - Andres F Abadia
- Division of Cardiovascular Imaging, Department of Radiology and Radiological Science, Medical University of South Carolina.
| | - Alessandro Posa
- Department of Diagnostic Imaging, Oncological Radiotherapy and Hematology, Fondazione Policlinico Universitario Agostino Gemelli - IRCCS, Rome, Italy.
| | - Antonio Corvino
- 1Motor Science and Wellness Department, University of Naples "Parthenope", via F. Acton 38, I-80133 Naples, Italy 2Advanced Biomedical Sciences Department, University Federico II of Naples (UNINA), via S. Pansini 5, I-80131 Naples Italy.
| | - Luigi Pasqualetto
- U.O.C. Radiologia, P.O. Sorrento, Ospedali riuniti "Area penisola Sorrentina" .
| | - Alfonso Presidente
- U.O.C. Radiologia, P.O. Sorrento, Ospedali riuniti "Area penisola Sorrentina" .
| | - Matteo Losco
- U.O.C. Radiologia, P.O. Sorrento, Ospedali riuniti "Area penisola Sorrentina" .
| | - Hunter N Gray
- Division of Cardiovascular Imaging, Department of Radiology and Radiological Science, Medical University of South Carolina .
| | - U Joseph Schoepf
- Division of Cardiovascular Imaging, Department of Radiology and Radiological Science, Medical University of South Carolina .
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Ostby SA, Evans JG, Smith HJ, Boitano TKL, Toboni MD, Heimann MA, Booth JS, Thomas JJ, Michael Straughn J. Reducing emergency department (ED) computed tomography (CT) utilization in women treated for gynecologic cancers. Gynecol Oncol 2019; 156:288-292. [PMID: 31767189 DOI: 10.1016/j.ygyno.2019.11.024] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/09/2019] [Revised: 11/13/2019] [Accepted: 11/17/2019] [Indexed: 11/17/2022]
Abstract
OBJECTIVES The objective of this quality improvement (QI) project was to decrease the rate of low-value computed tomography (CT) imaging in established gynecologic oncology patients presenting to the emergency department (ED). METHODS This was a cohort study with a before and after design that evaluated implementation of a QI project designed to decrease CT utilization in established gynecologic oncology patients in the ED. The pre-intervention cohort included patients admitted through the ED from 4/1/17 to 5/31/18, while the post-intervention cohort was from 6/1/18 to 5/31/19. The intervention included gynecologic oncology consultation before CT on patients who had imaging within the prior 3 weeks. Details regarding CT, ED length of stay (LOS), and oncologic history were abstracted. The value of CT was determined by consensus from 2 reviewers. Prospective data monitoring evaluated for patient safety. RESULTS Prior to intervention, there were 129 unique ED encounters in gynecologic oncology patients leading to admission. CT scans were performed in 101 (78.3%) encounters, 57.7% of which were deemed to be of low-value. Following implementation, the CT utilization rate decreased significantly from median monthly rate of 75.2% to 49.1% (p < 0.00001), and the ED LOS decreased from 8.1 to 6.9 h (p = 0.0102). The number of CT scans deemed to be low-value in the post-intervention group decreased to 2 (3.8%). CONCLUSIONS Implementation of an early consultation policy and imaging guidelines led to a significant decrease in unnecessary CT utilization and shorter ED LOS in gynecologic oncology patients presenting to the ED.
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Affiliation(s)
- Stuart A Ostby
- University of Alabama at Birmingham Department of Obstetrics & Gynecology, United States of America.
| | - Joel G Evans
- University of Alabama at Birmingham Division of Emergency Medicine, United States of America
| | - Haller J Smith
- University of Alabama at Birmingham Division of Gynecologic Oncology, United States of America
| | - Teresa K L Boitano
- University of Alabama at Birmingham Department of Obstetrics & Gynecology, United States of America
| | - Michael D Toboni
- University of Alabama at Birmingham Department of Obstetrics & Gynecology, United States of America
| | - Matthew A Heimann
- University of Alabama at Birmingham Division of Emergency Medicine, United States of America
| | - J Stu Booth
- University of Alabama at Birmingham Division of Emergency Medicine, United States of America
| | - Jarred J Thomas
- University of Alabama at Birmingham Division of Emergency Medicine, United States of America
| | - J Michael Straughn
- University of Alabama at Birmingham Division of Gynecologic Oncology, United States of America
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Hanna TN, Duszak R, Chahine A, Zygmont ME, Herr KD, Horný M. The Introduction and Development of the H-index for Imaging Utilizers: A Novel Metric for Quantifying Utilization of Emergency Department Imaging. Acad Emerg Med 2019; 26:1125-1134. [PMID: 31535443 DOI: 10.1111/acem.13765] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/11/2019] [Revised: 04/05/2019] [Accepted: 04/10/2019] [Indexed: 11/29/2022]
Abstract
OBJECTIVE The objective was to develop a novel metric for quantifying patient-level utilization of emergency department (ED) imaging. METHODS Using 2009 to 2015 Truven Health MarketScan commercial claims and encounters database, all ED visits and associated imaging services were identified. To measure imaging resource intensity, total imaging relative value units (RVUs) were calculated for each patient per ED visit. An individual's annual imaging h-index is defined as the largest number, h, such that h ED visits by that individual in a given year is associated with total medical imaging RVUs of a value of at least h. RESULTS Over 7 years, in a sample of 86,506,362 privately insured individuals (232,919,808 person-years) in all 50 states and the District of Columbia, 38,973,716 ED visits were identified. A total of 9.5% of person-years had one ED visit and 2.7% had two or more (the remainder had none). From 2009 to 2015, the percentage of ED patients undergoing imaging increased from 25.1% to 34.6%. Individuals with two or more ED visits each associated with two or more imaging RVUs (ED imaging h-index ≥ 2) comprised 0.2% of the sample and 1.4% of ED visitors; however, they accounted for 4.0% of ED visits and the use of 18.6% of imaging resources. From 2009 to 2015, imaging resource allocation for such patients increased from 16.5% to 21.0%. CONCLUSIONS The ED imaging h-index allows identification of patients who undergo significant ED imaging, based on a single-digit patient-specific metric that incorporates both annual ED visit number and medical imaging resource intensity per visit. While ED patients with an ED imaging h-index ≥ 2 represented a minuscule fraction of privately insured individuals, they were associated with one-fifth of all ED imaging resources.
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Affiliation(s)
- Tarek N. Hanna
- Department of Radiology and Imaging Sciences Emory University Atlanta GA
| | - Richard Duszak
- Department of Radiology and Imaging Sciences Emory University Atlanta GA
| | - Amanda Chahine
- Department of Radiology and Imaging Sciences Emory University Atlanta GA
| | - Matthew E. Zygmont
- Department of Radiology and Imaging Sciences Emory University Atlanta GA
| | - Keith D. Herr
- Department of Radiology and Imaging Sciences Emory University Atlanta GA
| | - Michal Horný
- Department of Radiology and Imaging Sciences Emory University Atlanta GA
- Department of Health Policy and Management Rollins School of Public Health Emory University Atlanta GA
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Kadakia K, Pfeifer CM, Cao J, O'Connell EJ, Kwon J, Browning T. Awareness of relative CT utilization among peers is not associated with changes in imaging requests among emergency department providers in a large county hospital. Emerg Radiol 2019; 27:17-22. [PMID: 31463804 DOI: 10.1007/s10140-019-01713-z] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/07/2019] [Accepted: 08/02/2019] [Indexed: 12/01/2022]
Abstract
PURPOSE The purpose of this quality improvement initiative was to study the effect of providing scorecards to emergency department providers to assess its effect on changes in utilization. METHODS CT of the abdomen and pelvis, CT angiogram of the chest for pulmonary embolism, and CT of the head were targeted due to ordering variability, cost, and radiation exposure. The utilization rate for each provider was assessed for emergency department providers. Following this, providers were given scorecards regarding their utilization as well as their relative utilization compared with each other. Utilization was then monitored following the intervention to assess the effect of the scorecard on ordering practices. RESULTS No significant effect on the utilization of these 3 exams was found after the scorecard intervention. CONCLUSION Providing scorecards to make emergency department providers aware of their relative utilization does not significantly alter ordering behavior. Incentive-based systems may be required in order to lessen overutilization of these 3 commonly ordered radiology procedures in the emergency department.
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Affiliation(s)
- Kevin Kadakia
- Department of Radiology, University of Texas Southwestern Medical Center, 5323 Harry Hines Blvd, Dallas, TX, 75390, USA.,Department of Radiology, Stanford University, 300 Pasteur Dr, Palo Alto, CA, 94304, USA
| | - Cory M Pfeifer
- Department of Radiology, University of Texas Southwestern Medical Center, 5323 Harry Hines Blvd, Dallas, TX, 75390, USA.
| | - Joseph Cao
- Department of Radiology, University of Texas Southwestern Medical Center, 5323 Harry Hines Blvd, Dallas, TX, 75390, USA
| | - Ellen J O'Connell
- Department of Emergency Medicine, University of Texas Southwestern Medical Center, 5323 Harry Hines Blvd, Dallas, TX, 75390, USA.,Parkland Health and Hospital System, 5200 Harry Hines Blvd, Dallas, TX, 75235, USA
| | - Jeannie Kwon
- Department of Radiology, University of Texas Southwestern Medical Center, 5323 Harry Hines Blvd, Dallas, TX, 75390, USA
| | - Travis Browning
- Department of Radiology, University of Texas Southwestern Medical Center, 5323 Harry Hines Blvd, Dallas, TX, 75390, USA.,Parkland Health and Hospital System, 5200 Harry Hines Blvd, Dallas, TX, 75235, USA
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Balakrishnan S. Highlights from the scientific and educational abstracts presented at the ASER 2017 annual scientific meeting and postgraduate course. Emerg Radiol 2018; 25:219-225. [PMID: 29594817 DOI: 10.1007/s10140-018-1599-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/05/2018] [Accepted: 03/08/2018] [Indexed: 10/17/2022]
Abstract
The annual meeting of the American Society of Emergency Radiology (ASER) took place in Toronto, Canada, on September 6 through September 9, 2017. Attendees represented the USA as well as international emergency radiology communities, including those from academic, private practice, and teleradiology settings. There were several "members in training" in attendance as well. The meeting again featured the "Trauma Head to Toe" 2-day didactic course, highlighting various important topics on imaging of traumatic injuries. Scattered throughout the 4 days were several poster and case of the day presentations, scientific sessions, and self-assessment modules. The following is a summary of the educational posters and scientific papers.
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Affiliation(s)
- Sudheer Balakrishnan
- Department of Radiology, Division of Emergency Radiology, Keck Hospital of University of Southern California, Los Angeles, CA, USA.
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