Quantity matters: Impact of PIT deployment on advanced imaging utilization

To determine the impact of Provider-in-Triage (PIT) deployment on advanced imaging utilization, including amongst patients presenting with abdominal pain.

This single-center retrospective study at a tertiary academic center evaluated changes in advanced imaging utilization following implementation of a PIT "split-flow" model in July 2023. Imaging incidence amongst adult Emergency Department (ED) patients was compared during the 18 months before and 18 months after PIT implementation using regression analysis adjusted for admission proportion and emergency severity index score. Additionally, patients presenting with abdominal pain in 2024 were evaluated for PIT exposure and computed tomography (CT) utilization adjusting for the covariates of age, sex, race, and admission disposition. CT positivity rates were compared between PIT and no-PIT cohorts.

There were 76,731 adult ED visits in the pre-PIT period and 89,105 in the PIT period. CT utilization increased from 0.36 to 0.49 studies per ED visit, with the PIT period associated with an absolute increase of 0.135 CTs per visit (p < 0.001). Smaller increases were observed for magnetic resonance imaging and radiology ultrasound, while point-of-care ultrasound (POCUS) showed a non-significant decrease. In the 2024 abdominal pain analysis, PIT was independently associated with increased CT utilization (OR 1.27, 95% CI 1.01-1.60). CT positivity was lower in the PIT cohort (38.7% vs 46.9%; absolute risk difference 8.2%, p = 0.03).

The deployment of PIT was associated with increased advanced imaging utilization. Patients exposed to PIT when arriving with a chief complaint of abdominal pain undergo more CT scans. Further work is needed to explore any possible causal relationship between PIT and advanced imaging utilization.