Does shifting to professional emergency department staffing affect the decision for chest radiography?

doi:10.5847/wjem.j.1920-8642.2021.02.001

Abstract

Abstract:

BACKGROUND: The study aims to determine whether shifting to professional emergency department (ED) teams leads to a higher rate of radiologic workup.

METHODS: We retrospectively analyzed a total of 2,000 patients presenting to the ED of a tertiary teaching hospital in two time periods: group 1 (G1) comprised 1,000 consecutive patients enrolled from December 21, 2012 to January 5, 2013 (all patients were examined by an internal medicine specialist); group 2 (G2) comprised 1,000 consecutive patients enrolled from December 21, 2018 to January 3, 2019 (all patients were examined by an emergency physician).

RESULTS: The chest X-ray (CXR) was performed in 40.6% of all patients. There was no difference in the frequency of CXR (38.9% in G1 vs. 42.3% in G2, P=0.152). More CXRs were performed in G2 patients older than 65 years, in female patients older than 65 years, in patients presenting during the evening and night shifts or off-hours, in patients with a history of malignancy, in patients with gastrointestinal bleeding, and in patients with bradycardia, but fewer in patients presenting with arrhythmia. No difference in the rates of pathological CXR was found (47.3% in G1 vs. 52.2% in G2, P=0.186). Compared with G2, higher sensitivity and specificity were obtained for the binary logistic regression model predicting pathological findings in G1.

CONCLUSIONS: Shifting to professional ED teams does not increase radiologic workup. By implementing deliberate usage of ultrasound, some self-governing procedures, case-oriented investigations, and center-specific recommendations, unnecessary radiologic workup can be avoided. Professional ED teams could lead to a higher standard of emergency care.

Key words: Chest radiography, Emergency department, Emergency physicians, Healthcare organization

Marin Pavlov, Lucija Klobučar, Iva Klobučar, Kristina Žgela, Vesna Degoricija. Does shifting to professional emergency department staffing affect the decision for chest radiography?[J]. World Journal of Emergency Medicine, 2021, 12(2): 87-92.

Figures/Tables 3

Figure 1.

Table 1

Table 2

References 23

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Groups	P	OR	95% CI for OR
Groups	P	OR	Lower	Upper
Group 1
Cough	<0.001	32.158	9.330	110.845
Dyspnea	<0.001	20.360	9.242	44.852
Fever	<0.001	10.878	4.253	27.824
GI bleeding	0.010	0.143	0.033	0.624
Chest pain	<0.001	3.776	2.438	5.849
Rales	<0.001	3.128	1.655	5.911
Oedema	0.047	2.166	1.011	4.640
Age	0.001	1.018	1.007	1.029
Group 2
Cough	<0.001	17.498	5.849	52.350
Dyspnea	<0.001	14.862	6.932	31.863
Arrhythmia	0.001	0.107	0.029	0.393
Rales	<0.001	7.107	2.780	18.167
Fever	<0.001	4.861	2.233	10.581
Chest pain	<0.001	4.172	2.727	6.381
GCS	0.003	0.793	0.679	0.925
Age	<0.001	1.020	1.011	1.030

Groups	P	OR	95% CI for OR
Groups	P	OR	Lower	Upper
Group 1
Age	<0.001	1.047	1.027	1.066
Dyspnea	<0.001	4.160	2.057	8.413
Cough	0.021	2.929	1.175	7.303
Rales	<0.001	5.535	2.839	10.792
Workday	0.037	0.526	0.288	0.961
Heart failure	0.045	2.475	1.021	6.000
GCS	<0.001	0.758	0.692	0.830
Group 2
Age	<0.001	1.031	1.018	1.045
Dyspnea	0.001	2.582	1.451	4.594
Cough	0.015	2.522	1.195	5.325
Rales	0.098	1.742	0.903	3.360
Male sex	0.056	0.640	0.405	1.011
Heart failure	0.005	3.031	1.386	6.628
GCS	<0.001	0.853	0.801	0.908

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