A collaborative multi site review: ED practices increase imaging requests in larger hospitals

Abstract

Objective: This study aims to compare imaging request patterns at four hospitals in Western Sydney. Expanding on previous research1, demonstrating imaging requests increase post introduction of NEAT (National Emergency Access Target). Method(s): Data for all e-orders from Westmead, Auburn, Blacktown and Mt Druitt hospitals were collected from the hospital information system from 1/7/2011 to 30/6/2016 and independently analysed for comparison. Linear trend over time was tested using F-statistics in a simple linear regression model. Nominal logistic regression was used to look at trends of utilisation of different modalities (X-ray, CT, US and others) over time at each hospital. Result(s): There was a significant linear trend (P < 0.0001), indicating that each quarter since June 2011, emergency department (ED) imaging requests increased proportionately at Westmead and Black-town hospitals (larger hospitals). No change in the number of imaging requests from ED was observed at Auburn Hospital (P = 0.134) (small hospital). No change in the number of requests from wards was noted at Westmead and Auburn hospitals (P = 0.11 and P = 0.21 respectively). A clear trend was observed over time across all sites with an increase in total proportion of CT requests. Conclusion(s): At larger hospitals, imaging requests from ED have increased since the introduction of NEAT. There was no decrease in ward imaging requests to compensate for the increase in imaging requests in ED at these hospitals, indicating that these increases are likely to result from ED practice changes. There was no increase in the imaging requests at smaller hospitals, indicating that NEAT may affect small and large hospitals differently.