title: Acute Abdomen in the Emergency Department: Is CT a Time-Limiting Factor?
abstract: OBJECTIVE
  The purpose of this study was to quantify and integrate key emergency department (ED) and radiology department workflow time intervals within the ED length of stay (LOS) for patients presenting with acute abdomen who require CT.
  
  
  METHODS
  An 11-month retrospective review was performed of all patients presenting to the ED with an acute abdomen who required abdominal CT. Nine key time points associated with ED LOS and CT workflow were collected: triage, physician assessment, CT request, porter schedule, CT start, CT complete, provision of first CT report, ED disposition decision, and physical discharge. The median and 90th percentile times for each interval were reported.
  
  
  RESULTS
  Ninety-six percent (2194/2292) of ED encounters during the study period met the inclusion criteria. The median ED LOS was 9.22 hours (90th percentile, 15.7 hours). Intervals associated with CT workflow accounted for 29% of the total LOS. Radiology turnaround time accounted for 32% of the entire CT workflow interval. Timeline analysis found three unique patterns of ED disposition: disposition after initial imaging report, disposition before report, and disposition before CT.
  
  
  CONCLUSIONS
  To our knowledge, this study is the first to quantify the contribution of CT-related workflow time intervals within the context of ED LOS. We have shown that patients do not have identical ED transit pathways, and this may under- or overestimate time interval calculations. These results show the importance of site-specific ED LOS timeline analysis to identify potential targets for quality improvement and serve as baseline targets for measuring future quality improvement initiatives.
authors.affiliation: 1 Faculty of Medicine, University of Toronto, Toronto, ON, Canada.
authors.forename: David Chenhan
authors.initials: DC
authors.lastname: Wang
authors.affiliation: 2 Department of Medical Imaging, University Hospital of Wales, Cardiff, United Kingdom.
authors.forename: Craig R
authors.initials: CR
authors.lastname: Parry
authors.affiliation: 3 Department of Emergency Medicine, University of Toronto, Toronto, ON, Canada.
authors.forename: Michael
authors.initials: M
authors.lastname: Feldman
authors.affiliation: 4 Institute of Health Policy, Management & Evaluation, University of Toronto, Toronto, ON Canada.
authors.forename: George
authors.initials: G
authors.lastname: Tomlinson
authors.affiliation: 5 Department of Medical Imaging, Sunnybrook Health Sciences Centre, 2075 Bayview Ave, Toronto, ON M4N 3M5, Canada.
authors.forename: Josée
authors.initials: J
authors.lastname: Sarrazin
authors.affiliation: 5 Department of Medical Imaging, Sunnybrook Health Sciences Centre, 2075 Bayview Ave, Toronto, ON M4N 3M5, Canada.
authors.forename: Phyllis
authors.initials: P
authors.lastname: Glanc
mesh_terms: D000006:Abdomen, Acute / Q000000981:diagnostic imaging*; D003287:Contrast Media; D004636:Emergency Service, Hospital; D005260:Female; D006801:Humans; D007902:Length of Stay / Q000706:statistics & numerical data*; D008297:Male; D008875:Middle Aged; D012189:Retrospective Studies; D014057:Tomography, X-Ray Computed / Q000379:methods*; D014218:Triage
chemical_list: D003287:Contrast Media
keywords: CT abdomen and pelvis; acute abdomen; emergency department; length of stay; medical imaging; turnaround time; wait times