Quantity matters: Impact of PIT deployment on advanced imaging utilization

Area of Science:

• Emergency Medicine
• Radiology
• Health Services Research

Background:

• Provider-in-Triage (PIT) models are increasingly implemented in Emergency Departments (EDs).
• The impact of PIT on advanced imaging utilization, a significant driver of healthcare costs, requires investigation.
• Understanding imaging trends in specific patient cohorts, such as those with abdominal pain, is crucial.

Purpose of the Study:

• To evaluate the effect of PIT implementation on advanced imaging use in an academic ED.
• To specifically assess changes in computed tomography (CT) utilization for patients presenting with abdominal pain.

Main Methods:

• A single-center retrospective study compared 18 months pre-PIT and 18 months post-PIT implementation.
• Advanced imaging utilization was analyzed using regression models, adjusting for patient acuity and admission rates.
• CT utilization and positivity rates were compared between PIT-exposed and non-PIT-exposed patients presenting with abdominal pain.

Main Results:

• Overall CT utilization increased significantly post-PIT implementation (0.36 to 0.49 studies per ED visit).
• PIT was independently associated with increased CT utilization in patients with abdominal pain (OR 1.27).
• CT scans in the PIT cohort for abdominal pain showed a lower positivity rate (38.7% vs 46.9%).

Conclusions:

• PIT deployment is associated with a rise in advanced imaging utilization within the ED.
• Patients with abdominal pain managed under PIT guidelines underwent more CT scans.
• Further research is warranted to establish a causal link and understand the implications of these imaging trends.