title: Protecting trauma patients from duplicated computed tomography scans: the relevance of integrated care systems.
abstract: BACKGROUND
  Duplicated computed tomography (CT) scans in transferred trauma patients have been described in university-based trauma systems. This study compares CT utilization between a university-based nonintegrated system (NIS) and a vertically integrated regional healthcare system (IS).
  
  
  METHODS
  Trauma patients transferred to 2 Level I trauma centers were prospectively identified at the time of transfer. Imaging obtained before and subsequent to transfer and the reason for CT imaging at the Level I center were captured by real-time reporting.
  
  
  RESULTS
  Four hundred eighty-one patients were reviewed (207 at NIS and 274 at IS). Ninety-nine patients (48%) at NIS and 45 (16%) at IS underwent duplicate scanning of at least one body region. Inadequate scan quality and incomplete imaging were the most common reason category reported at NIS (54%) and IS (78%).
  
  
  CONCLUSIONS
  Fewer patients received duplicated scans within the vertically IS as compared with a traditional university-based referral system. Our findings suggest that the adoption of features of a vertically IS, particularly improved transferability of radiographic studies, may improve patient care in other system types.
authors.affiliation: Department of Surgery, University of Wisconsin, Madison, WI, USA. Electronic address: liepert@surgery.wisc.edu.
authors.forename: Amy E
authors.initials: AE
authors.lastname: Liepert
authors.affiliation: Department of Emergency Medicine, Murray, UT, USA.
authors.forename: Joseph
authors.initials: J
authors.lastname: Bledsoe
authors.affiliation: Department of Surgery, Intermountain Medical Center, Murray, UT, USA.
authors.forename: Mark H
authors.initials: MH
authors.lastname: Stevens
authors.affiliation: Department of Surgery, University of Utah, Salt Lake City, UT, USA.
authors.forename: Amalia
authors.initials: A
authors.lastname: Cochran
mesh_terms: D019033:Delivery of Health Care, Integrated; D005500:Follow-Up Studies; D006801:Humans; D015994:Incidence; D011446:Prospective Studies; D011829:Radiation Dosage; D011832:Radiation Injuries / Q000453:epidemiology / Q000517:prevention & control*; D014057:Tomography, X-Ray Computed / Q000706:statistics & numerical data*; D014193:Trauma Centers / Q000706:statistics & numerical data*; D014481:United States; D019564:Unnecessary Procedures / Q000706:statistics & numerical data*; D014947:Wounds and Injuries / Q000000981:diagnostic imaging*
keywords: Duplicated CT scans; Interfacility transfer; Trauma care