Nearly all emergency departments (EDs) are experiencing long wait times, patient boarding, and high rates of patients left without being seen (LWBS). Pre-pandemic, the national average for LWBS was 1.1%. Post pandemic, the national average has more than doubled to 2.5%, reaching as high as 10% in some hospitals.1 With more than half of all hospital patients coming through the ED, these factors directly impact patient outcomes, experience, and hospital revenue.
ED performance is based almost entirely on process metrics, such as the time of patient arrival to the ED to the time the patient has a disposition, the “ED length of stay” (LOS).2 This ED LOS is tracked daily by many ED leaders as a measure of patient flow through the department. A major bottleneck in the ED is CT scanning. Patients waiting their turn to obtain a CT, often adds crucial minutes to hours onto the overall patient visit. With one or more patients experiencing this wait during their visit, this also directly affects the ED's capacity to see new patients.
When analyzing the time course for the ED work-up of mild traumatic brain injury, Michelson et al. developed a theoretical model to demonstrate that approximately “one-half of the time associated with the current typical ED evaluation work-up of suspected mild traumatic brain injury (mTBI) is the result of the decision to order and the time and resources necessary to complete and obtain an interpretation of a head CT.”3
The authors go on to state that the steps of ordering, waiting, transporting, obtaining, and reviewing a head CT adds approximately 151 minutes to the total ED LOS. Therefore, the authors suggest, “elimination of the head CT and all related steps . . . would result in an estimated time savings of 151 minutes, as a substantial proportion of the time required to assess suspected mTBI was attributable to steps following the decision to order a CT.”3
BrainScope is a point-of-care decision support tool that can be rapidly deployed in the ED to triage mild head injured patients and determine the need for a head CT. Within fifteen minutes and using AI-derived algorithms, BrainScope provides Emergency Clinicians with both the likelihood of having an intracranial hemorrhage and likelihood and severity of brain function impairment, such as concussion. BrainScope demonstrated a 99% sensitivity in identifying the likelihood of the smallest detectable level of intracranial blood (>1 mL) in patients with minor head injury.4 These objective measures give both clinicians and their patient’s objective information related to their head trauma without ionizing radiation.
Hospitals that integrate BrainScope into the triage of minor head injured patients have seen a CT diversion rate of approximately 40% in the ED. In a 40,000 visit/year ED with approximately 1,000 mild head injured patients, this means approximately 270 patients will not receive a head CT, saving a total of 680 hours of length of stay.
The cumulative time savings in the ED LOS would translate into the capacity to see approximately 260 more patients per year, using the average ED LOS of 156 minutes (680 hours/2.6 hours). Additionally, is is estimated about 27% of all ED patients receive a CT scan of some type.5 Reducing CT utilization for mild head injured patients also creates capacity for new patients to receive a CT scan. If each of these visits are billed at the national average for an E&M Level Three visit, the institution should expect additional revenue of $42,100 - $50,400 in facility fees alone, and an additional $10,000 in technical fees for CT scans.6,7
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1. Janke AT, Melnick ER, Venkatesh AK. Monthly Rates of Patients Who Left Before Accessing Care in US Emergency Departments, 2017-2021. JAMA Netw Open. 2022;5(9):e2233708. doi:10.1001/jamanetworkopen.2022.33708
2. Section 3. Measuring Emergency Department Performance. Content last reviewed April 2020. Agency for Healthcare Research and Quality, Rockville, MD. https://www.ahrq.gov/research/findings/final-reports/ptflow/section3.html (accessed 8 Nov 2022)
3. Michelson, E. A., Huff, J. S., Loparo, M., Naunheim, R. S., Perron, A., Rahm, M., ... & Berger, A. (2018). Emergency department time course for mild traumatic brain injury workup. Western Journal of Emergency Medicine, 19(4), 635.
4. Hanley, D., Prichep, L. S., Bazarian, J., Huff, J. S., Naunheim, R., Garrett, J., ... & Hack, D. C. (2017). Emergency department triage of traumatic head injury using a brain electrical activity biomarker: a multisite prospective observational validation trial. Academic emergency medicine, 24(5), 617-627.
5. Statistical Trends in the Emergency Department (ACEP) https://www.acepnow.com/article/statistical-trends-of-diagnostic-testing-in-the-emergency-department/ {Accessed 0817, 2022)
6. ACEP Ambulatory Payment Classification FAQ, https://www.acep.org/administration/reimbursement/reimbursement-faqs/apc-ambulatory-payment-classificationsfaq/ (accessed August 1, 2022)
7.CMS - Search the Physician Fee Schedule, https://www.cms.gov/medicare/physician-fee-schedule/search (accessed August 1, 2022)
