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Background: As emergency department (ED) overcrowding affects timely patient care, strategies such as standardize protocols are required.
Objective: The purpose of this study was to 1) investigate impact of utilizing various Computed Tomography (CT) scans modalities namely CT without contrast (WO), with contrast (W), and with and without contrast (WWO) in diagnosing kidney stones on ED operational metrics (i.e., CT order to report time, room to discharge, and ED length of stay), and 2) develop, implement, and test kidney stone protocols.
Methods: The study included both retrospective, cross-sectional and pre/post analyses of patients presenting to the ED of a large, academic medical center with suspicion of kidney stone who received CT scans from December 2010 to December 2011. ANOVA, t-test, Chi-Square test, and linear regression were used for statistical analyses.
Results: During pre implementation, statistically significant difference of at least 41.7 minutes were observed between CT WO and CT WWO for all operational metrics After implementation of the kidney stone protocol (i.e., switching to CT WO contrast) the order compliance rate improved from 35.9% to 72.8%, with similar savings for CT order to report times.
Conclusions: With 37% additional patients evaluated using CT WO and ¾ to 1 hour savings in CT order to report time, the estimated net capacity gain is 32 to 43 routine ED patients for a 50,000 volume ED. Thus, standardization of protocol using the developed framework for other common diseases (e.g., abdominal pain) may add ED capacity and revenue while reducing ED overcrowding issues.
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