Implementing electronic health record-based workflow solutions to improve emergency room CT exam turnaround time at a county safety net hospital

Purpose: Five major electronic medical record (EMR)-based workflow solutions were implemented to improve emergency CT exam turnaround time. First, kidney function and pregnancy screening policies were operationalized into the EMR exam order. Second, exam order pick lists were created (e.g., trauma, stroke, etc.) to guide clinicians on appropriate exam selection. Third, order-protocol guidance sheets were produced to enable radiology technologists to protocol uncomplicated exams. Fourth, a “CT Technologist Details” EMR tab was generated to display necessary information required before a patient is transported (e.g., intravenous access, screening tests, etc.) Finally, EMR-based banners were used to communicate availability of patient transporters with emergency department staff.

Methods/Materials: The median exam order to patient arrival time (Ord to Arr), patient arrival to exam beginning time (Arr to Beg), exam order to exam beginning time (Ord to Beg), and exam order to final report time (Ord to Final) were calculated from first quarter of 2020 to second quarter of 2023. The total number of CT exams performed during each quarter was measured. Implementation timeline and screenshots of EMR-based workflow solutions were produced.

Results: During 2020, 20,136 exams were completed with Ord to Beg time measuring 64, 54, 63, and 59 minutes each quarter respectively. During 2021, 24,597 exams were completed with Ord to Beg time measuring 62, 73, 53, and 51 minutes each quarter respectively. During 2022, 26,273 exams were completed with Ord to Beg time measuring 42, 38, 39, and 44 minutes each quarter respectively. During the first half of 2023, 13,440 exams were completed with Ord to Beg time measuring 39 and 36 minutes each quarter respectively.

Conclusions: Despite a rising number of exams, implementing EMR-based workflow solutions significantly improved CT exam turnaround time with a reduction in Ord to Beg time of 22.5 minutes (37.5%) since 2020. This improvement is attributed to the combination of EMR-based changes. EMR-based workflow solutions may be utilized by institutions seeking to improve emergency CT exam turnaround times.