Academic Medical Center Enhances CT Turnaround in Emergency Department

A quality improvement initiative significantly reduced computed tomography (CT) turnaround times (TAT) in the emergency department (ED) of a metropolitan academic medical center. The effort targeted improvements by integrating a new workflow for radiology resident interpretations and teleradiology services.

Amidst increasing patient volumes and overcrowding, optimizing operational efficiency remains crucial for EDs across the United States. At the academic center studied, overnight CT TATs were initially above national benchmarks. A significant portion of this delay stemmed from the time between preliminary imaging reads by radiology residents and the initiation of third-party attending-level teleradiology interpretations.

Utilizing the Plan-Do-Study-Act (PDSA) framework, this single-center quality improvement study aimed to reduce the interval between preliminary resident reads and teleradiology requests by 25%. Adult ED patients undergoing overnight CT imaging in need of teleradiology interpretation were included in this project, which ran from March 21, 2022, to May 1, 2025.

The study involved four sequential PDSA cycles, each implementing a distinct intervention. The interventions were designed to enhance communication between emergency physicians, health unit clerks, and radiology residents. They included: the use of imaging order code phrases to denote discharge intentions, automated worklist-driven referrals, an electronic medical record (EMR)-integrated teleradiology request function on the ED track board, and a radiology-initiated digital "Request Nighthawk Read" button.

Over the study period, involving 12,126 patients, significant improvements were recorded. The comparison included a baseline group of 3,058 patients before intervention and 3,698 patients after implementing PDSA Cycle 4. The median time from preliminary read to teleradiology request decreased from 30.5 minutes to 21.6 minutes, a reduction of 29.2% (p <0.001). Additionally, the total CT order-to-result TAT decreased from 157.3 to 130.0 minutes, representing a 17.4% reduction (p <0.001). The CT exam completion-to-result time also saw a decrease, moving from 84.2 to 72.6 minutes, a 13.8% reduction (p <0.001).

Although the ED arrival-to-discharge time modestly reduced from 413 to 396 minutes (4.1% reduction; p = 0.43), the EMR-integrated workflow heightened transparency and communication without incurring additional costs. This initiative highlights a replicable, cost-effective strategy for academic institutions managing dual resident-led and teleradiology overnight workflows, ultimately fostering greater efficiency and improved patient care outcomes.