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Emergency department imaging superusers

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Abstract

Purpose

To identify and characterize the most frequent users of emergency department (ED) imaging.

Materials and methods

All patients with at least one ED visit in 2016 across a four-hospital healthcare system were retrospectively identified and their ED imaging utilization characterized.

Results

Overall, 126,940 unique patients underwent 187,603 ED visits (mean 1.5 ± 1.7) and a total of 192,142 imaging examinations (mean 1.7 ± 2.7). Fifty-eight percent of patients were imaged (73,672) and underwent a mean 2.6 ± 2.7 exams. When ranked by ED visits, 1.6% (2007) of patients had ≥ 4 ED visits (mean 6.1 ± 5.4). These ED “clinical superusers” accounted for 7.7% (14,409) of total ED visits and underwent 6.8 ± 5.4 imaging examinations, while non-superusers underwent 1.5 ± 2.2 (p < 0.01). When ranked by ED imaging utilization, 12.3% (15,575) of patients underwent ≥ 4 ED imaging examinations and consumed 49.5% (95,053) of all imaging services. A subset of just 1.3% (1608) of ED patients underwent > 10 annual ED examinations (ED “imaging superusers”) and accounted for 12.4% (23,787) of all ED imaging services. Only 0.4% (n = 472) of patients were both clinical and imaging superusers. Despite similar ED visits to clinical superusers (6.0 ± 5.6 vs. 6.1 ± 5.4, p = 0.92), imaging superusers underwent significantly more imaging (14.8 ± 4.8 vs. 6.8 ± 5.4 examinations, p < 0.01).

Conclusion

Just 12% of ED patients consume 50% of all ED imaging services, and 1.3% consume 12.4%. These ED imaging superusers represent a distinct group from clinical superusers. Prospective identification of this newly described subgroup might permit targeted interventions to control ED imaging volume, restrain costs, and minimize per-patient radiation exposure.

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IRB statement

This study was reviewed and approved by our institutional IRB.

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Authors and Affiliations

  1. Department of Radiology and Imaging Sciences, Emory University School of Medicine, 1364 Clifton Road NE, Atlanta, GA, 30322, USA

    Tarek N. Hanna, Kush Singh, Michal Horný & Adam Prater

  2. Division of Emergency and Trauma Imaging, Department of Radiology and Imaging Sciences, Emory University Midtown Hospital, 550 Peachtree Road, Atlanta, GA, 30308, USA

    Tarek N. Hanna

  3. Department of Biostatistics and Bioinformatics, Rollins School of Public Health, Emory University, Atlanta, GA, 30322, USA

    Suprateek Kundu & Richard Duszak Jr

  4. Department of Health Policy and Management, Rollins School of Public Health, Emory University, Atlanta, GA, 30322, USA

    Michal Horný

  5. Department of Emergency Medicine, Emory University School of Medicine, Atlanta, GA, 30322, USA

    Daniel Wood

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  1. Tarek N. Hanna
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Correspondence to Tarek N. Hanna.

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The authors declare that they have no conflict of interest.

Disclosures

MH and RD receive research support from the Harvey L. Neiman Health Policy Institute (Reston, VA). TNH is a 2017–2018 recipient of the American Society of Emergency Radiology Educational Grant.

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Hanna, T.N., Kundu, S., Singh, K. et al. Emergency department imaging superusers. Emerg Radiol 26, 161–168 (2019). https://doi.org/10.1007/s10140-018-1659-y

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  • DOI: https://doi.org/10.1007/s10140-018-1659-y

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