Abstract
Purpose
To determine the effect of discontinuing routine oral contrast material on emergency department (ED) length of stay (LOS), time from order to CT completion, and preliminary report turnaround time (TAT).
Methods
A HIPAA-compliant, IRB-waived, single-institution, retrospective cohort study was conducted on adult patients presenting with abdominal pain to the ED from October 2015 to April 2019. Routine oral contrast material was administered prior to July 2018 and discontinued thereafter. CT workflow (ED LOS, exam completion time, report TAT) data were analyzed in a univariate analysis before and after discontinuation of oral contrast. Pre- versus post-policy data were compared with 2-sided t tests. The primary outcome was ED LOS. Data were analyzed on a process control chart and confidence limits were adjusted using established criteria.
Results
There were 5020 included abdominopelvic CTs. After routine oral contrast material was discontinued, ED LOS (13.4 h vs 10.7 h, p < 0.001) and time from CT order to CT completion (2.7 h vs 2.1 h, p < 0.001) declined. However, control chart analysis revealed improvement in overall LOS preceded the policy change by 9 months, while improvement in time to CT completion coincided with the policy change. Preliminary report TAT increased by 4 min after the policy change (29 min vs. 33 min, p < 0.001).
Conclusions
Discontinuation of routine oral contrast material in the ED accelerated time to CT completion but had a minor non-significant effect on overall ED LOS. Much of the reduction in overall LOS likely was due to unrelated process improvements.
This is a preview of subscription content, log in via an institution to check access.
Similar content being viewed by others
References
Fishman EK. Spiral CT: applications in the emergency patient. Radiographics. 1996;16(4):943-948.
Rao PM, Rhea JT, Novelline RA, et al. Helical CT with only colonic contrast material for diagnosing diverticulitis: prospective evaluation of 150 patients. AJR Am J Roentgenol. 1998;170(6):1445-1449.
Uyeda JW, Yu H, Ramalingam V, Devalapalli AP, Soto JA, Anderson SW. Evaluation of Acute Abdominal Pain in the Emergency Setting Using Computed Tomography Without Oral Contrast in Patients With Body Mass Index Greater Than 25. J Comput Assist Tomogr. 2015;39(5):681-686.
Alabousi A, Patlas MN, Sne N, Katz DS. Is Oral Contrast Necessary for Multidetector Computed Tomography Imaging of Patients With Acute Abdominal Pain? Can Assoc Radiol J. 2015;66(4):318-322.
Kessner R, Barnes S, Halpern P, Makrin V, Blachar A. CT for Acute Nontraumatic Abdominal Pain-Is Oral Contrast Really Required? Acad Radiol. 2017;24(7):840-845.
Shankar PR, Parikh KR, Heilbrun ME, et al. Cost Implications of Oral Contrast Administration in the Emergency Department: A Time-Driven Activity-Based Costing Analysis. J Am Coll Radiol. 2019;16(1):30-38.
Schuur JD, Chu G, Sucov A. Effect of oral contrast for abdominal computed tomography on emergency department length of stay. Emerg Radiol. 2010;17(4):267-273.
Gardner RM, Friedman NA, Carlson M, Bradham TS, Barrett TW. Impact of revised triage to improve throughput in an ED with limited traditional fast track population. Am J Emerg Med. 2018;36(1):124–127.
Chang AM, Lin A, Fu R, McConnell KJ, Sun B. Associations of Emergency Department Length of Stay With Publicly Reported Quality-of-care Measures. Acad Emerg Med. 2017;24(2):246-250.
Median Time from ED Arrival to ED Departure for Discharged ED Patients. Published 2018. Accessed 03/25/2020, 2020.
Zocchi MS, McClelland MS, Pines JM. Increasing Throughput: Results from a 42-Hospital Collaborative to Improve Emergency Department Flow. Jt Comm J Qual Patient Saf. 2015;41(12):532-542.
Basile J, Kenny JF, Khodorkovsky B, et al. Effects of eliminating routine use of oral contrast for computed tomography of the abdomen and pelvis: A pilot study. Clin Imaging. 2018;49:159-162.
Razavi SA, Johnson JO, Kassin MT, Applegate KE. The impact of introducing a no oral contrast abdominopelvic CT examination (NOCAPE) pathway on radiology turn around times, emergency department length of stay, and patient safety. Emerg Radiol. 2014;21(6):605-613.
McNeese B. Control Chart Rules and Interpretation. BPI Consulting, LLC. https://www.spcforexcel.com/knowledge/control-chart-basics/control-chart-rules-interpretation. Published 2016. Accessed 02/21/2020, 2020.
Hanna TN, Streicher DA, Razavi SA, Khosa F, Johnson JO, Applegate KE. Enteric Distribution of Oral Contrast in Emergency Department Patients Undergoing Abdominal-Pelvic Computed Tomography. Can Assoc Radiol J. 2016;67(3):204-211.
Driesen B, van Riet BHG, Verkerk L, Bonjer HJ, Merten H, Nanayakkara PWB. Long length of stay at the emergency department is mostly caused by organisational factors outside the influence of the emergency department: A root cause analysis. PLoS One. 2018;13(9):e0202751.
Acknowledgements
We are grateful to Manaswini Rayappureddi and Kenneth Mitchell for their support with this project.
Funding
None.
Author information
Authors and Affiliations
Corresponding author
Ethics declarations
Conflict of interest
The authors declare no conflicts of interest.
Ethical approval
The Loma Linda University IRB deemed that this study did not meet the definition of human subjects research and thereby waived the requirement for IRB review or approval.
Additional information
Publisher's Note
Springer Nature remains neutral with regard to jurisdictional claims in published maps and institutional affiliations.
Kevin Kim and Nelly Tan are co-first authors and contributed equally to this work.
Rights and permissions
About this article
Cite this article
Kim, K.Y., Tan, N., Moretz, J. et al. Emergency department length of stay following discontinuation of routine oral contrast material. Abdom Radiol 46, 1210–1215 (2021). https://doi.org/10.1007/s00261-020-02722-0
Received:
Revised:
Accepted:
Published:
Issue Date:
DOI: https://doi.org/10.1007/s00261-020-02722-0