Study objective

We assessed whether the timing and order of patients over emergency shifts are associated with receiving diagnostic imaging in the emergency department and characterized whether changes in imaging are associated with changes in patients returning to the ED.

Methods

In this retrospective study, we used multivariate and instrumental variable regressions to examine how the timing and order of patients are associated with the use of diagnostic imaging. Outcomes include whether a patient receives a radiograph, a computed tomography (CT) scan, an ultrasound, and 7-day bouncebacks to the ED. The variables of interest are time and order during a physician’s shift in which a patient is seen.

Results

A total of 841,683 ED visits were examined from an administrative database of all ED visits to Niagara Health. Relative to the first patient, the probability of receiving a radiograph, CT, and ultrasound decreases by 6.4%, 9.1%, and 3.8% if a patient is the 15th patient seen during a shift. Relative to the first minute, the probability of receiving a radiograph, CT, or ultrasound increases by 1.9%, 2.7%, and 1.1% if a patient is seen in the 180th minute. Seven-day bounceback rates are not consistently associated with patient order or timing in a shift and imaging orders.

Conclusion

Imaging in the ED is associated with shift length and especially patient order, suggesting that physicians make different imaging decisions over the course of their shifts. Additional imaging does not translate into reductions in subsequent bouncebacks to the hospital.

中文翻译：

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患者顺序和轮班时间如何与急诊科的成像选择相关联？来自尼亚加拉卫生行政数据的证据

学习目标

我们评估了患者急诊轮班的时间和顺序是否与在急诊科接受诊断影像学检查有关，并确定了影像学检查的变化是否与返回急诊室的患者的变化有关。

方法

在这项回顾性研究中，我们使用多变量和工具变量回归来检查患者的时间和顺序如何与诊断成像的使用相关联。结果包括患者是否接受 X 光片、计算机断层扫描 (CT) 扫描、超声检查以及 7 天回诊。感兴趣的变量是医生轮班期间看病人的时间和顺序。

结果

从 Niagara Health 的所有急诊就诊管理数据库中检查了总共 841,683 次急诊就诊。相对于第一位患者，如果患者是轮班期间看到的第 15 位患者，则接受 X 光片、CT 和超声检查的概率分别降低 6.4%、9.1% 和 3.8%。相对于第一分钟，如果患者在第 180 分钟就诊，则接受 X 光片、CT 或超声检查的概率分别增加 1.9%、2.7% 和 1.1%。7 天反弹率与患者订单或轮班时间和成像订单的时间并不一致。

结论

急诊室的成像与轮班时间长短相关，尤其是患者顺序，这表明医生在轮班过程中会做出不同的成像决定。额外的成像不会转化为减少随后返回医院的次数。