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Major Increase in CT Scans in Hospital Emergency Departments

Posted Dec 15 2010 12:00am

It will come as a no surprise to readers of this blog that the practice of medicine is changing radically, particularly the use of CT scans and other diagnostic studies. Part of the shift is due to the fact that younger physicians are losing their ability to diagnose at the bedside. Part is due to the increasing sophistication of imaging technology itself. Certainly part is due to the pressure to practice defensive medicine. A recent article puts some real numbers to this shift in the use of CT scans in hospital emergency departments (see: Use of CT Scans in Emergency Departments 'Skyrocketing' ). Below is an excerpt from the article:

The use of computed tomography (CT) scans in emergency departments (EDs) throughout the United States has increased dramatically in recent years, and this increase shows little signs of slowing, according to a study presented [at RSNA]. From 1995 to 2007, the number of visits in which a CT scan was performed increased 6-fold, from 2.7 million to 16.2 million, representing a growth rate of 16% per year, said [the author of the study]  The percentage of visits that were associated with a CT scan also increased substantially, from 2.8% of all visits in 1995 to 13.9% of all visits in 2007, [he] said. He and his team examined data from the Centers for Disease Control and Prevention's National Hospital Ambulatory Medical Care Survey, which collects data on approximately 30,000 emergency visits each year. CT use was greater in older patients, white patients, patients admitted to the hospital, and in hospitals located in urban areas. Toward the end of the study period, most CTs were for abdominal pain, headache, and chest pain....According to [the study author], it is not just the magnitude of the growth in CT scanning that is so striking, but the nature of that growth. "When you look at the model of how technology diffuses in a population, it usually starts with accelerating growth and then, after a period of time, it begins to decelerate and taper off. But the use of CT scans is still in the acceleration phase, at least in 2007. It hasn't even started to taper by this time period, so we've seen very rapid, steady, and sustained growth." He added that there is no question that in the setting of a life-threatening injury or severe illness, a CT is appropriate. "The real question is when an indication is less clear, where there is less severe illness. At what point do you draw the line and say no to CT? It is such a great test, it is an excellent modality, and in some ways it's harder to make the decision not to do it."

Managing an emergency department (ED) in a hospital is a complex task. All hospitals are seeking ways to increase patient through-put in their EDs including the use of scribes to input data into the EMR (see: Shift of Hospital EMR Data Entry Tasks from MDs to Scribes ). In many hospitals, problems arise in the staffing of the units, causing hospital administrators to turn to hiring more hospitalists (see: Specialist Staffing Problems Arise in General Hospital ERs ). A large percentage of hospital inpatients are admitted through the ED so it's important to rapidly triage the patients who arrive at the door. Three major patient categories include those that can be quickly diagnosed as having minor problems, those who required a short stay for observation, and the sickest among them who need to be admitted for acute care. To provide care to those who require short-term observation, units staffed by hospitalists are being opened (see: Taking charge of observation units: With hospitalists at the helm, these units aren't just for chest pain any more ). This allows the high-intensity hospital beds to be reserved for the most sick.

Obviously, the increased use of CT scans drives up the cost of healthcare (see: CTs, MRIs, and PET Scans Drive Cost of Healthcare Upward ). However, the expectation of most people who arrive at the ED these days is that their abdominal pain, headache, and chest pain complaints will be rapidly and accurately diagnosed. It is therefore unlikely that this trend toward the increased use of sophisticated imaging in the ED will be reversed at any time in the near future. Look for these CT number to continue to increase. Hopefully, increased volume, new technology, and pressure from payers will drive down the cost of the procedure.

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