A multidisciplinary timeout may benefit transferred trauma patients by preventing a substantial number of unnecessary repeat CT studies.
Berger
According to results presented in a Tuesday session, a brief, intentional delay, or "time‑out" can allow time for receiving trauma service and imaging team personnel to evaluate potential technical, procedural, cultural and clinical reasons why imaging should, or should not, be repeated.
“It’s useful to draw attention to opportunities to reduce repeat imaging in an effort to limit patient exposure to potentially harmful radiation and intravenous iodinated contrast,” said Ferco H. Berger, MD, EDER, associate professor in the Department of Medical Imaging at University of Toronto.
Dr. Berger is also an associate scientist, deputy chief of operations and head of the Emergency & Trauma Radiology Division of the Precision Diagnostics & Therapeutics Program at Sunnybrook Health Sciences Center.
“Looking at prior CTs from other centers—if available and time allows—will help maximize efficiency and will help tailor the CT protocol performed at the receiving hospital,” Dr. Berger said. “This could lead to better pickup rates of injury in patients and potentially reduce time to treatment.”
Local Factors Affect Implementation of Time-Out Protocol
Building on prior experience, Dr. Berger and colleagues conducted a two-phase study evaluating local factors contributing to repeat CTs in transferred trauma patients arriving at his institution’s Level 1 trauma center.
In Phase 1, the researchers observed the standard CT ordering process for 318 transferred patients and noted reasons for repeating the CTs, such as unavailable or inadequate imaging or a lack of confidence in the outside report.
For Phase 2, the intervention phase which included 98 patients, the receiving trauma team evaluated patients clinically, while in-house radiologists reviewed the outside CT images to determine if they met local standards.
“The teams subsequently discussed imaging and clinical findings during an ‘imaging time-out’, which limited further CTs to only the exams that were still considered to be indicated,” Dr. Berger said.
Dr. Berger and his team tracked CTs that might have been performed without the imaging time-out and documented all CTs by body region and protocol.
Between Phases 1 and 2, the team identified a 29% reduction in the number of CT studies performed and a 24% reduction in estimated radiation exposure. In Phase 2, they prevented 45% of potential additional CTs and 43% of potential radiation exposure.
Dr. Berger acknowledged challenges in applying an imaging time-out protocol and said local factors at the receiving institution affect if and how it might be implemented. He said that a new common reporting room in his institution’s ED, and a new team of overnight in-house emergency and trauma radiologists who deal with all trauma imaging, allowed for reader facilitation of the imaging time-out.
“It’s important to understand that local factors sometimes differ, but modern IT solutions like PACS and electronic communication can help radiologists working in different areas implement a similar protocol,” Dr. Berger said.
