CT ordering patterns for abdominal pain by physician in triage

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Abstract

Background

Overcrowding in the Emergency Department is a problem with many strategies for intervention such as the physician in triage (PIT). This brief evaluation is designed to minimize diagnostic uncertainty and expedite the work up when the patient is seen in the Emergency Department. We hypothesized that this would increase CT imaging which would be increasingly negative as the pressure to maintain throughput rises on busy days in the Emergency Department.

Methods

We designed a retrospective study in which ordering patterns of Emergency physicians was explored using a group of patients with abdominal pain, presenting to triage in a 2 year period. We compared CT ordering rates on the 5% highest and lowest volume days (HD5 and LD5) and examined the bivariate relationship between volume and imaging utilization.

Results

There was no statistical significance in the rate of CT's ordered collectively by PIT physicians on HD5 compared with LD5 with a p-value of 0.25. There is a trend toward increased utilization when each physician is compared to themselves on HD5 vs. LD5 but these were not statistically significant differences. The percentage of “clinically relevant” CTs was not determined to be different, but there was an increase in the LOS when a CT was ordered on both LD5 and HD5 (HD5 p-value 0.009; LD5 p-value 0.0004).

Conclusion

There is no difference in CT ordering patterns for abdominal pain by PIT between HD5 and LD5. Likewise CT ordering patterns do not demonstrate a difference in percentage of clinically relevant CTs.

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