Digital imaging at a community hospital: implications for hospital stays and teleradiology

Two key questions for the cost-effectiveness of digital imaging concern its likely impact on average inpatient stays and the prevalence of applications for teleradiology. Little empirical evidence is available because of the state of the technology, but useful evidence can be drawn from conventional imaging departments. This paper reports a survey of admitting physicians and draws inferences about the likely effects of conversion to digital imaging. Published cost estimates for this Canadian community hospital show that conversion to digital imaging is likely to increase medical imaging costs despite shorter examination times. However, digital imaging could produce net savings hospital-wide by improving the efficiency of diagnosis and treatment sufficiently to reduce the length of patient stays. In this sample, no inpatient medical imaging examinations lengthened a stay in a way likely to be averted by digital imaging (95% confidence interval 0% to 2%), and probability testing rejects the hypothesis that digital imaging will reduce hospital stays sufficiently to produce net savings at this hospital. Based on these results, it appears premature to assume that digital imaging will significantly reduce length of stay for most inpatients. On teleradiology, physicians either exchanged films with other medical imaging centres or indicated they would have sent or received teleradiology images for 17% of inpatient medical imaging examinations (95% confidence interval 10-24%). Since outpatient procedures comprise 60% of the medical imaging workload at Victoria General Hospital, further study would be required to estimate overall use of teleradiology.