Reducing Emergency Department Length of Stay: Designing an Evidence-Based Guideline for Oral Contrast Use in Abdominopelvic CTs
Creators:Slivinski, Andrea K.
Advisor:Momeyer, Mary Alice
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Publisher:The Ohio State University
Series/Report no.:The Ohio State University. College of Nursing Doctor of Nursing Practice Final Document Projects
Prolonged emergency department length of stay has gained attention and momentum in the healthcare arena over the last several years. ED crowding and inefficient process of patients have negatively affected the quality of care, leading to increased inpatient mortality, adverse events, lengthier inpatient stays, and increased overall resource use. ED length of stay metrics within the project site consistently performs below state and national benchmarks. It is imperative for the organization to adopt evidence-based practice strategies to reduce ED length of stay and improve the overall patient experience. The use of oral and intravenous contrast agents for patients who present with abdominal pain and receive an abdominopelvic CT is the current standard of practice in the project sites’ ED. In the last decade, the use of oral contrast has become questionable in terms of distinct benefits to the quality of the exam. In many settings, providers use personal discretion to decide if oral contrast is truly beneficial. The purpose of this project was to construct an evidence based practice guideline to support the discretionary use of oral contrast in abdominopelvic CTs. In a large urban ED on the east coast, this interdisciplinary effort involved key stakeholders, including emergency medicine physicians, radiologists, general surgery and hospitalist providers, medical imaging technologists, and nursing and medical imaging leadership. Baseline data for contrast usage and associated cost was shared with the stakeholder group in addition to a draft evidence-based guideline for oral contrast use. After revisions, key stakeholders approved the guideline and a plan for implementation into current practice was developed to guide oral contrast use in abdominopelvic CTs to improve ED efficiency while maintaining equivocal CT results.