CT in your ED? Make sure you’ve got enough space

Budget constraints may not be greatest challenge

Although purchasing a new computed tomography (CT) scanner and associated software can cost upward of $1 million (used and/or refurbished machines may cost half that), money may not be the biggest obstacle to putting a CT scanner in your ED, say experts.

"These days, the challenge is not so much cost as it is space," says Paul Paris, MD, chairman of the department of emergency medicine at the University of Pittsburgh School of Medicine.

His recommendation? "What larger hospitals will do is use [an additional CT in the ED] for overflow from elsewhere in the hospital," he says. "For smaller hospitals, well, everyone needs at least one, so the smart thing is to put one in the ED and use it for emergency patients as well as for other patients."

It is easy to medically justify the need to have a CT scanner in the ED, Paris continues. "First of all, it is becoming the standard of care to use CT for a variety of diagnoses," he asserts.

"One of the most common presentations is chest pain, and currently the safest and best way to diagnose a pulmonary embolism is with a spiral CT. When you have a scanner in the hospital, but not in the ED, most ED docs will tell you that’s an unsafe place for patients to be — in a CT scanner," Paris adds. "They can have cardiac arrest or respiratory failure," he notes. "If that happens outside the ED, it’s very hard to properly care for the patient."

There are many other conditions for which CT is the best test, Paris continues. "A very common complaint is abdominal pain, and CT has become the study of choice to rule out appendicitis," he observes. "For trauma, it is the procedure of choice for looking at the cervical spine, chest, or belly. It gives the most information for many conditions. For severe headache or any bleeding in the brain, it’s the study you need immediately."

Still, Paris concedes, space is a nagging problem. "The number of EDs has gone from 7,000 to 4,000, while yearly visits have risen from 17 million to 115 million," he says. "Everyone is outgrowing their space. But if a hospital is expanding, you should clearly plan for a CT in the ED."

Another strategy for justifying a CT scanner in your ED is to link it to a departmentwide performance improvement (PI) initiative. That linkage was the key to success at Baptist East Hospital in Louisville, KY. Baptist East already had a CT in radiology, but the administrators wanted a second machine for the ED.

"We were looking at ways to improve turnaround time in the ED for patient throughput," recalls Cheryl Stout, RN, MSN, director of nursing at the 407-bed facility.

Baptist East sees 50,000 patients a year and performs 18,000 CTs each year. "At the same time, radiology does a lot of inpatient, outpatient, and ED work and needed an additional scanner," Stout explains. "We felt that if we could put it somewhere in the ED, we could direct traffic there and avoid taking patients into the radiology department, and it would also become available for ED patients."

Important as it was, the request for an additional CT in the ED was just one of many elements of the PI initiative. "We looked at bedside registration, dedicated transporters to transport patients upstairs within seven minutes, a dedicated tube system from the ED to the lab, and so on," she notes.

Was it beneficial for the request for a CT to be part of the overall initiative, rather than an isolated request to upper management from the ED manager? Absolutely, Stout contends.

"It’s significant because it’s such a huge capital request," she stresses. Any request of that magnitude needs to be put in a business plan, to show what the return on investment will be, Stout says.

"We showed that by having an additional CT, it would enable the hospital to continuously book additional outpatients and that the volume would be there to support the additional expense," she notes.

In addition, radiology was supportive. "They said it would make life easier for them, and they worked hard to make it happen," Stout says. "We had the space available once we did a small renovation, which was included as part of the whole PI process."

Stout admits sometimes different hospital departments can get territorial, "but the emphasis was put on overall changes and input came from all departments."

At Baptist East, she reports, "We all love [the new CT], and it has been borne out in terms of cost benefit."

Sources

For more information on CT scanners in the ED, contact:

  • Paul Paris, Chairman, Department of Emergency Medicine, University of Pittsburgh School of Medicine. Phone: (412) 670-9950. E-mail: parispm@upmc.edu.
  • Cheryl Stout, RN, MSN, Baptist East Hospital, Louisville, KY. Phone: (502) 897-8299. E-mail: cstout@bhsi.com.