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J Trauma Acute Care Surg. 2016 Jan;80(1):51-4; discussion 54-6. doi: 10.1097/TA.0000000000000866.

Implementation of an image sharing system significantly reduced repeat computed tomographic imaging in a regional trauma system.

Author information

1
From the Division of Trauma, Critical Care, Burns, and Acute Care Surgery, Metro Health Medical Center (A.B., B.M.Z., D.A., P.A.W., R.F., J.A.C.), Case Western Reserve University; and Cleveland Clinic Regional Hospitals (D.A.), Cleveland, Ohio.

Abstract

BACKGROUND:

The practice of repeating computed tomography (re-CT) is common among trauma patients transferred between hospitals incurring additional cost and radiation exposure. This study sought to evaluate the effectiveness of implementing modern cloud-based technology (lifeIMAGE) across a regional trauma system to reduce the incidence of re-CT imaging.

METHODS:

This is a prospective interventional study to evaluate outcomes after implementation of lifeIMAGE in January 2012. Key outcomes were rates of CT imaging, including the rates and costs of re-CT from January 2009 through December 2012.

RESULTS:

There were 1,081 trauma patients transferred from participating hospitals during the study period (657 patients before and 425 patients after implementation), with the overall re-CT rate of 20.5%. Rates of any CT imaging at referring hospitals decreased (62% vs. 55%, p < 0.05) and also decreased at the accepting regional Level I center (58% vs. 52%, p < 0.05) following system implementation. There were 639 patients (59%) who had CT imaging performed before transfer (404 patients before and 235 patients after implementation). Of these patients, the overall re-CT rate decreased from 38.4% to 28.1% (p = 0.01). Rates of re-CT of the head (21% vs. 11%, p = 0.002), chest (7% vs. 3%, p = 0.05), as well as abdomen and pelvis (12% vs. 5%, p = 0.007) were significantly reduced following system implementation. The cost of repeat imaging per patient was significantly lower following system implementation (mean charges, $1,046 vs. $589; p < 0.001). These results were more pronounced in a subgroup of patients with an Injury Severity Score (ISS) of greater than 14, with a reduction in overall re-CT rate from 51% to 30% (p = 0.03).

CONCLUSION:

The implementation of modern cloud-based technology across the regional trauma system resulted in significant reductions in re-CT imaging and cost.

LEVEL OF EVIDENCE:

Therapeutic/care management study, level IV; economic analysis, level IV.

PMID:
26683391
DOI:
10.1097/TA.0000000000000866
[Indexed for MEDLINE]

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