Using an ED expeditor decreases turnaround times, improves CT workflow

Using a dedicated expeditor in the emergency department (ED) can improve CT imaging workflow, according to a new case study published in the Journal of the American College of Radiology.

The researchers, led by Soterios Gyftopoulos, MD, MSc, of New York University’s Langone Medical Center, noted that the number of ED visits that include CT imaging in some form has increased from 2.7 to 16.2 million over a 12-year period. Additionally, ED visits that include CT imaging as part of the workup increased from 2.8 to 13.9 percent over the same period.

“Improving the turnaround times (TATs) of CT imaging could improve the efficiency of patient management in the ED by allowing for quicker patient triage and treatment allocation,” Gyftopoulos and colleagues wrote.

To improve those TATs, the researchers determined that implementing an ED-based radiology expeditor would “be in the best position” to aid in the pre-CT scan steps and prioritize studies through straight conversations with the primary ED provider and nursing team.

The expeditor was stationed in the ED patient area over a three-month period, and ED staff were notified of the new position. The expeditor’s main function was to coordinate the workup the patient needed to be cleared for CT imaging. 

Upon implementation of the expeditor, the researchers found the ordered-to-scheduled TAT for non-contrast, contrast and all CTs decreased by 50 percent, 25 percent and 35 percent, respectively. There were also decreases in the ordered-to-completed TAT for non-contrast, contrast and all CTs by 24 percent, 18 percent and 22 percent, respectively. Each of these changes to TATs were statistically significant. Additionally, the length of stay for patients who were treated and released decreased by 4 percent and the decrease in admitted patients was 12 percent.

According to survey results the researchers sent to ED physicians, 75 percent of respondents reported the expeditor improved the time it took to get a CT exam in the ED. About 80 percent of the respondents noted that the role would be a valuable resource during additional ED shifts.

After the expeditor pilot ended, the researchers said their ED performance returned to its original level. 

NYU Langone is in the process of requesting funding for a permanent position. The researchers also believe they would have seen additional decreases in TATs as the expeditor, ED staff and radiology services gained more experience working with each other. 

“We believe that an expanded version of this role, which includes the coordination of the other ED imaging modalities, has the potential to greatly improve the safety and efficiency of patient throughput in this clinical setting,” the researchers concluded.