Imaging Utilization On the Rise in Emergency Departments

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Utilization rates for imaging procedures in hospital emergency departments (EDs) are increasing, indicates a study published in the October issue of the Journal of the American College of Radiology.

Involving queries of nationwide Medicare Part B databases for 2000 to 2008, the study shows a 60% hike in the overall utilization rate per 1,000 Medicare beneficiaries for all imaging in EDs, from 281.0 in 2000 to 450.4 in 2008. The radiography utilization rate rose by 29%, from 227.3 procedures per 1,000 beneficiaries in 2000 to 294.3 procedures per 1,000 beneficiaries in 2008, with 67 accrued new studies per 1,000 beneficiaries.

Shown to be on an even sharper uptick was the CT rate, which rose from 40.0 per 1,000 Medicare beneficiaries in 2000 to 130.7procedures per 1,000 Medicare beneficiaries in 2008. This represents an increase of 227% and includes 90.7 accrued new studies per 1,000 beneficiaries.

The study’s authors cite a number of possible reasons for the reported rapid increase in CT utilization. “For one, as CT has become faster and more accurate, the indications for its use have expanded,” they write. Additionally, they point out, EDs are experiencing ever-increasing caseloads, exerting great pressure on physicians to increase patient throughput.

Enhanced access to CT scanners also ranks on this list, as in recent years, many hospitals have installed CT units in or adjacent to their EDs, the researchers assert. Finally, they believe increased pressure for diagnostic certainty among ED physicians, and “all other physicians for that matter”, may be pushing the envelope.

Meanwhile, according to the study, the ultrasound rate saw a 95.9% increase, from 9.6 procedures per 1,000 beneficiaries in 2000 to 18.7 procedures per 1,000 beneficiaries in 2008. There were 9.1 accrued new studies per 1,000 beneficiaries for the modality.

Utilization rates for other modalities were much lower. Notably, in 2000, CT constituted 14% of all imaging procedures performed in EDs and just 29% eight years later.

In 2008, radiologists performed 96% of all ED imaging examinations, the study indicates.Radiologists strongly predominate in ED CT, radiography, and non-cardiac ultrasound, the study’s authors say.

“Although this fact is encouraging for radiologists, it is likely that hospitals will begin to expect them to work more closely with ED physicians in the future to try and use more clinical rules and appropriateness criteria to limit imaging growth,” they write.

To read the full text, click here: http://www.jacr.org/article/S1546-1440%2811%2900174-8/fulltext