CT ordering patterns for abdominal pain by physician in triage

Emergency departments face persistent challenges with overcrowding. Physician in triage (PIT) is one strategy to address this issue. Prior research has shown that PIT can help reduce diagnostic uncertainty early in the patient journey. However, the impact of PIT on diagnostic imaging decisions remains unclear. This gap motivated a study to examine whether CT ordering patterns differ based on emergency department volume. No prior work had resolved how high-volume days might influence imaging decisions in triage. Understanding these patterns could inform strategies to optimize patient flow. The study focused on abdominal pain, a common presenting complaint. Researchers sought to determine if CT utilization varied with patient volume. They also aimed to assess whether clinically relevant findings changed with increased imaging.

The study aimed to evaluate whether physician in triage (PIT) CT ordering patterns for abdominal pain change on high-volume versus low-volume emergency department days. The researchers hypothesized that increased pressure to maintain throughput on busy days might lead to more CT orders. They also wanted to assess if the proportion of clinically relevant CT findings varied with volume. The focus was on a specific diagnostic decision point in triage. The study used a retrospective design to compare ordering behaviors. Researchers examined data from a two-year period to identify trends. They compared CT ordering rates on the top 5% busiest days versus the least busy days. The goal was to determine if workload influenced diagnostic imaging decisions.

The study used a retrospective design to analyze CT ordering patterns in a two-year dataset. Researchers focused on patients presenting with abdominal pain to triage. They categorized days into the top 5% highest volume (HD5) and lowest volume (LD5). Data were collected on CT orders placed by physician in triage (PIT) staff. The researchers compared ordering rates between HD5 and LD5 days. They also examined the relationship between patient volume and imaging utilization. The study assessed whether CT orders led to clinically relevant findings. Length of stay (LOS) was measured after CT orders on both HD5 and LD5 days. Statistical analysis included bivariate comparisons and p-values to assess significance.

The study found no statistically significant difference in CT ordering rates between HD5 and LD5 days (p=0.25). While there was a trend toward increased utilization on high-volume days, it was not significant when comparing individual physicians. The percentage of clinically relevant CT findings did not differ between the two groups. Length of stay (LOS) increased when a CT was ordered on both HD5 and LD5 days. On HD5, the LOS increase had a p-value of 0.009. On LD5, the increase was even more significant with a p-value of 0.0004. These findings suggest that CT orders may prolong patient stay regardless of department volume. No evidence supported the hypothesis that CT utilization rises on busy days. The data showed consistent ordering patterns across different workload levels.

The authors concluded that CT ordering patterns for abdominal pain by physician in triage (PIT) do not differ significantly between high and low volume days. They found no evidence that increased workload leads to higher CT utilization. The proportion of clinically relevant CT findings remained unchanged. The study showed that CT orders may increase length of stay on both busy and quiet days. These findings suggest that workload does not drive increased imaging decisions. The researchers propose that diagnostic decisions in triage remain consistent regardless of patient volume. No essential change in physician behavior was observed. The authors suggest that further research could explore factors influencing CT utilization in triage settings.