Root Cause Analysis of Delayed Emergency Department Computed Tomography Scans

Area of Science:

• Emergency Medicine
• Radiology
• Healthcare Operations

Background:

• Emergency department (ED) congestion is a significant healthcare challenge.
• Increasing reliance on advanced imaging, such as computed tomography (CT), contributes to ED bottlenecks.
• CT turnaround time is a critical factor impacting ED patient flow and care.

Purpose of the Study:

• To identify factors contributing to significant delays in CT scan completion within an urban, tertiary care ED.
• To analyze the prevalence and causes of extended CT turnaround times.

Main Methods:

• Retrospective analysis of 5,685 CT scans performed on 4,344 patients over a three-month period.
• Definition of outliers as CT scans exceeding 369 minutes from order to completion.
• Systematic chart review of outlier cases to identify contributing factors and their frequencies.

Main Results:

• 182 outliers (4.2% of total CTs) were identified, with 167 analyzed after exclusions.
• Key delay factors included: patient non-compliance/instability (22.8%), intravenous (IV) line issues (18.0%), contrast allergies (14.4%), glomerular filtration rate (GFR) concerns (12.6%), and imaging protocol issues (12.0%).
• A significant portion of delays (32.9%) had an unknown cause.

Conclusions:

• Both modifiable and non-modifiable factors contribute to delayed ED CT scans.
• Patient-related factors (behavior, acuity, allergies) are significant but unchangeable.
• Institutional policies addressing IV access, contrast use in low GFR, and imaging protocols offer opportunities for improvement, potentially mitigating up to 42.6% of delays.