Heart CT scans in ERs save hospitals billions

Despite cautions to curb image testing, a new study in the New England Journal of Medicine (NEJM) found that conducting heart CT scans in the emergency department actually can save hospitals billions of dollars.

Researchers from the American College of Radiology Imaging Network (ACRIN) found that low- to intermediate-risk patients who had coronary CT angiography scans were twice as likely to be discharged (49.6 percent versus 22.7 percent) and had significantly shorter hospital stays than patients who received traditional care (18 hours versus 24.8 hours), Forbes reported.

According to a study based on 2006-2007 data from the Hospital of the University of Pennsylvania, conducting CT scans in emergency rooms saved $2,500 per patient, Reuters reported.

Although nearly 6 million people go the emergency department for chest pain--the most common reason that patients come to the emergency department--only 10-15 percent of them turn out to have an acute coronary syndrome (ACS), and most are admitted to the hospital, according to Forbes.

The CT scans help providers detect heart conditions that might otherwise go undetected. The heart CT scans more likely detected coronary disease in 9 percent of CT emergency cases versus 3.5 percent in traditional care, according to the article.

In addition to the potential cost savings and the detection benefits, Judd Hollander, the trial's co-principal investigator and the clinical research director in the University of Pennsylvania emergency department, said scanning emergency patients can help reserve emergency services for truly emergent cases.

"We know that having patients in the ED who don't require emergent care actually serves to increase the mortality rate for other patients in the ED who are acutely ill," Hollander said in an ACR announcement. "CCTA could enable us to discharge a large subset of chest pain patients after finding they are not at risk for a cardiac event, and thus enhance the care for everybody who comes through the ED."

Using heart CT scans could help alleviate ED crowding, added study lead researcher Harold Litt, chief of cardiovascular imaging in the Radiology Department at the Perelman School of Medicine at the University of Pennsylvania.

"I think the data is very convincing," Litt told Reuters. "There have been smaller studies like this, but this is the first one that's large enough to show ... that is safe to send someone home after a CT scan."

"We think most of the cost saving is in faster discharges," Litt said. "ER crowding is a major issue. All patients do worse when there's crowding."

For more information:
- check out the study abstract
- here's the press release
- read the Reuters article
- read the Forbes article

Related Articles:
CT scan use varies greatly between docs in same ED
Study: Popular whole-body CT scans for ER use have dangers
CMS measure to curb CT use 'unreliable'
Joint Commission proposal against overtesting, excessive procedures
Report: Medical imaging spending drops 13%

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