title: Clinical information available during emergency department imaging order entry and radiologist interpretation.
abstract: OBJECTIVE
  The objective of this study was to evaluate the proportion of Emergency Department (ED) radiology examinations ordered or interpreted prior to a documented clinical assessment.
  
  
  METHODS
  We collected 600 retrospective consecutive ED cases consisting equally of patients whose first ED imaging examination was computed tomography (CT), radiography (XR), or ultrasonography (US). For each patient, the following times were documented: ED arrival, ED departure, ED length of stay (LOS), imaging order entry, image availability, radiology report availability, triage note, ED provider note, and laboratory results.
  
  
  RESULTS
  Mean age was 44.2, 66.5% female, and mean ED LOS was 326.2 min. ED LOS was longer for patients who received CT versus XR (343.9 vs. 311.3; p = 0.029). In 25.5% of XR, 10% of CT, and 8% of US cases, the imaging exam was completed before the ED provider note was started. In 20.5% of XR, 6.5% of CT, and 6% of US cases, the radiologist did not have the ED provider note available prior to completing their diagnostic interpretation. In 33.4% of all cases and 57.5% of XR cases, incomplete clinical documentation (triage note, provider note, lab results) was available during radiology report creation. CT and US exams more frequently had clinical data available prior to radiologist interpretation than XR (p < 0.0001). Radiologist turn-around-time was unaffected by clinical information availability.
  
  
  CONCLUSIONS
  Eight percent of ED CT and 10% of ED US examinations were ordered and completed before documented clinical assessment. Thirty-three percent had incomplete clinical assessment performed prior to image interpretation. Further investigation is needed to determine impact on interpretation accuracy.
authors.affiliation: Division of Emergency Radiology, Department of Radiology and Imaging Sciences, Emory University Midtown Hospital, 550 Peachtree Road, Atlanta, GA, 30308, USA. 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 Midtown Hospital, 550 Peachtree Road, Atlanta, GA, 30308, USA.
authors.forename: Saurabh
authors.initials: S
authors.lastname: Rohatgi
authors.affiliation: Division of Emergency Radiology, Department of Radiology and Imaging Sciences, Emory University Midtown Hospital, 550 Peachtree Road, Atlanta, GA, 30308, USA.
authors.forename: Haris N
authors.initials: HN
authors.lastname: Shekhani
authors.affiliation: Rollins School of Public Health, Emory University, Atlanta, GA, 30322, USA.
authors.forename: Ishaan Amit
authors.initials: IA
authors.lastname: Dave
authors.affiliation: Division of Emergency Radiology, Department of Radiology and Imaging Sciences, Emory University Midtown Hospital, 550 Peachtree Road, Atlanta, GA, 30308, USA.
authors.forename: Jamlik-Omari
authors.initials: JO
authors.lastname: Johnson
mesh_terms: D000328:Adult; D003952:Diagnostic Imaging; D004282:Documentation; D004636:Emergency Service, Hospital; D005260:Female; D006801:Humans; D007902:Length of Stay / Q000706:statistics & numerical data; D008297:Male; D050316:Medical Order Entry Systems; D012189:Retrospective Studies; D013997:Time Factors; D014218:Triage
keywords: Clinical information; Emergency department; History; Radiology; Turn-around time; Workflow