Abstract
BackgroundRadiographic examinations of the ankle are important in the clinical management of ankle injuries in hospital emergency departments. National (Australian) Emergency Access Targets (NEAT) stipulate that 90 percent of presentations should leave the emergency department within 4 hours. For a radiological report to have clinical usefulness and relevance to clinical teams treating patients with ankle injuries in emergency departments, the report would need to be prepared and available to the clinical team within the NEAT 4 hour timeframe; before the patient has left the emergency department. However, little is known about the demand profile of ankle injuries requiring radiographic examination or time until radiological reports are available for this clinical group in Australian public hospital emergency settings.MethodsThis study utilised a prospective cohort of consecutive cases of ankle examinations from patients (n = 437) with suspected traumatic ankle injuries presenting to the emergency department of a tertiary hospital facility. Time stamps from the hospital Picture Archiving and Communication System were used to record the timing of three processing milestones for each patient’s radiographic examination; the time of image acquisition, time of a provisional radiological report being made available for viewing by referring clinical teams, and time of final verification of radiological report.ResultsRadiological reports and all three time stamps were available for 431 (98.6%) cases and were included in analysis. The total time between image acquisition and final radiological report verification exceeded 4 hours for 404 (92.5%) cases. The peak demand for radiographic examination of ankles was on weekend days, and in the afternoon and evening. The majority of examinations were provisionally reported and verified during weekday daytime shift hours.ConclusionsProvisional or final radiological reports were frequently not available within 4 hours of image acquisition among this sample. Effective and cost-efficient strategies to improve the support provided to referring clinical teams from medical imaging departments may enhance emergency care interventions for people presenting to emergency departments with ankle injuries; particularly those with imaging findings that may be challenging for junior clinical staff to interpret without a definitive radiological report.
Highlights
Radiographic examinations of the ankle are important in the clinical management of ankle injuries in hospital emergency departments
Little is known about the demand profile of ankle injuries requiring radiographic examination or time until radiological reports are available for this clinical group in Australian public hospital emergency settings
The demand for radiographic ankle examinations peaked on weekend days (Figure 1a), and in the afternoon and evening (Figure 1b)
Summary
Radiographic examinations of the ankle are important in the clinical management of ankle injuries in hospital emergency departments. Little is known about the demand profile of ankle injuries requiring radiographic examination or time until radiological reports are available for this clinical group in Australian public hospital emergency settings. It has been reported that between 5–12% of all patients who attend the emergency department involve an ankle injury [7,8,9]. Missed and or delayed diagnoses in the emergency department can have severe consequences and are a major patient safety concern [11,12]. Emergency departments often have inexperienced junior doctors seeing large numbers of patients of all ages every day; errors or missed diagnoses do occur [13,14]. The severity of life impact may not necessarily be dependent on the severity of the initial trauma, but sub-optimal clinical management could contribute to chronic and persistent conditions [15,17]
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