Emergency Department Switching and Duplicate Computed Tomography Scans in Patients With Kidney Stones

Abstract

To test whether duplicate imaging relates to a lack of information sharing among providers, we measured the association between emergency department (ED) switching during a kidney stone episode and receipt of a repeat computed tomography (CT) scan. Using the MarketScan Commercial Claims and Encounters Database, we identified adults between the ages 18 and 64 with an ED visit for a diagnosis of kidney stones. Among patients who had an abdominal or pelvic CT scan at their initial encounter, we then determined the subset that made an ED revisit within 30 days of their first, distinguishing between those to the same vs a different ED. Finally, we fit multivariable logistic regression models to estimate the risk of receiving a repeat CT scan associated with ED switching. Twelve percent of patients who received a CT scan at their initial ED encounter had a revisit within 30 days of discharge. One-third of their revisits were made to a different ED than the index one. Duplicate CT scans were obtained at nearly 40% of all revisits. On multivariable analysis, the risk of receiving a repeat CT was 12% higher if this revisit was made to a different ED (risk ratio, 1.12; 95% confidence interval, 1.03-1.21; P = .010). Our study reveals that ED switching during an acute kidney stone episode is associated with higher levels of repeat CT imaging. These findings support the role of better health information exchange among providers to help reduce waste in the health-care system.