title: Inefficient Resource Use for Patients Who Receive Both a Chest Radiograph and Chest CT in a Single Emergency Department Visit.
abstract: OBJECTIVE
  The goal of this study was to examine emergency department (ED) ordering practices in patients receiving both chest radiography (CXR) and chest CT (CCT).
  
  
  METHODS
  Consecutive ED patients receiving both CXR and CCT in a single ED visit from January 2009 to December 2013 were included. For each examination, the time of order entry, time of study completion, and time of final interpretation were recorded and analyzed.
  
  
  RESULTS
  A total of 3,627 patients met the inclusion criteria. In 3,437 (94.8%) patients, the CXR was ordered first; in 43 (1.2%), the CCT was ordered first; and in 91 (2.5%), the CCT and CXR were ordered simultaneously. In 50.3% (1,826 of 3,627) of all cases, imaging in the second modality (whether CCT or CXR) was ordered before final report availability of the first exam. In 9.8% (n = 354 of 3,627) of all cases, imaging in the second modality (whether CCT or CXR) was ordered before image availability from the first examination.
  
  
  CONCLUSIONS
  These results suggest inefficient resource usage, for which targeted technology solutions may be helpful.
authors.affiliation: Division of Emergency Radiology, Department of Radiology and Imaging Sciences, Emory University School of Medicine, Atlanta, Georgia. Electronic address: tarek.hanna@emory.edu.
authors.forename: Tarek N
authors.initials: TN
authors.lastname: Hanna
authors.affiliation: Division of Emergency Radiology, Department of Radiology and Imaging Sciences, Emory University School of Medicine, Atlanta, Georgia.
authors.forename: Waqas
authors.initials: W
authors.lastname: Shuaib
authors.affiliation: Division of Emergency Radiology, Department of Radiology and Imaging Sciences, Emory University School of Medicine, Atlanta, Georgia.
authors.forename: James M
authors.initials: JM
authors.lastname: Kerchberger
authors.affiliation: Division of Emergency Radiology, Department of Radiology and Imaging Sciences, Emory University School of Medicine, Atlanta, Georgia.
authors.forename: Jamlik-Omari
authors.initials: JO
authors.lastname: Johnson
authors.affiliation: Division of Emergency Radiology, Department of Radiology and Imaging Sciences, Emory University School of Medicine, Atlanta, Georgia.
authors.forename: Faisal
authors.initials: F
authors.lastname: Khosa
mesh_terms: D017598:Efficiency, Organizational; D004636:Emergency Service, Hospital; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D010818:Practice Patterns, Physicians' / Q000706:statistics & numerical data*; D013902:Radiography, Thoracic; D012189:Retrospective Studies; D013896:Thoracic Diseases / Q000000981:diagnostic imaging*; D014057:Tomography, X-Ray Computed
keywords: CT; Radiology; chest radiography; emergency department; informatics