title: Identification of root causes for emergency diagnostic imaging delays at three Canadian hospitals.
abstract: BACKGROUND
  Diagnostic imaging of patients in the emergency department offers numerous opportunities for delay. In an era of ED overcrowding, it is important to identify causes of delay in caring for patients to minimize patient length of stay in the emergency department.
  
  
  OBJECTIVE
  This study was intended to: (1) identify each of the steps involved in completing emergency diagnostic imaging investigations; (2) identify points of delay in the process; (3) identify the root causes for delay; and (4) perform a barrier analysis to provide insight into the contribution of the work environment and existing processes to delays.
  
  
  METHODS
  This prospective, cross-sectional, modified time-in-motion study was conducted simultaneously at 3 urban emergency departments of a Canadian academic center over a 3-week period. Turnaround and process event times were recorded and a log transformation was performed to normalize the time data. Analysis of variance was used to examine individual time intervals between sites. Root cause and barrier analyses were conducted on the summary data.
  
  
  RESULTS
  Analysis of 2297 cases revealed the mean turnaround time for one site was 50 minutes and significantly greater (P < .05) than the means of the other 2 sites (approximately 33 and 37 minutes, respectively). Root cause analysis identified 3 root causes of delay: (1) processing of radiograph request order by registered nurse; (2) transport times; and (3) radiology suite location. Barrier analysis indicated that current practices are responsible for the first 2 causes of delay.
  
  
  CONCLUSIONS
  Both radiology and emergency department staffing considerations and workload contribute to delays in turnaround times of diagnostic imaging investigations.
authors.affiliation: Department of Emergency Medicine, Hamilton Health Sciences, Hamilton, Ontario, Canada. aworster@rogers.com
authors.forename: Andrew
authors.initials: A
authors.lastname: Worster
authors.forename: Christopher M B
authors.initials: CM
authors.lastname: Fernandes
authors.forename: Cheryl
authors.initials: C
authors.lastname: Malcolmson
authors.forename: Kevin
authors.initials: K
authors.lastname: Eva
authors.forename: Diane
authors.initials: D
authors.lastname: Simpson
mesh_terms: D003430:Cross-Sectional Studies; D003952:Diagnostic Imaging; D017598:Efficiency, Organizational; D016529:Emergency Nursing; D004636:Emergency Service, Hospital / Q000458:organization & administration*; D017144:Focus Groups; D006801:Humans; D009864:Ontario; D011446:Prospective Studies; D013997:Time Factors; D013996:Time and Motion Studies