Import Outside Images on ED Transfer: Fewer Repeat Exams, says Study

April 22, 2011

Importing radiology exams into a picture archiving and communications system (PACS) after an emergency department (ED) transfer cuts subsequent imaging by up to 17 percent during the first 24 hours, according to a study just released online by Radiology.

There’s a lot of talk about how online records can give doctors a more complete picture of a patient’s condition within a hospital or medical system, while reducing duplicate testing. But what happens when a patient is transferred to another facility? Importing radiology exams into a picture archiving and communications system (PACS) after an emergency department (ED) transfer cuts subsequent imaging by up to 17 percent during the first 24 hours, according to a study just released online by Radiology. The study will be published in the July print issue.

The retrospective single-site study, conducted at Brigham and Women’s Hospital, looked at 1,487 consecutive ED patients, for whom doctors attempted to import CD images into the PACS system for seven months in 2009. Researchers looked at what imaging studies were done within 24 hours of the ED transfer admission, comparing rates of studies for those whose records were successfully imported to those for whom import failed.

According to lead author Aaron Sodickson, MD, PhD, 2.2 million patients are transferred yearly between EDs. Since patients are commonly transferred from smaller facilities to larger ones, with imaging-heavy diagnoses of trauma, stroke and intracranial hemorrhage, the imaging studies are crucial to treatment and follow-up.

The study found that CD import to PACS was successful 78 percent of the time (1,161 patients), and this produced a 17 percent reduction in total diagnostic imaging in the 24 hours after transfer (lowering the mean number of studies per patient from 3.3 in the failed import group to 2.74 in the successful import group).

When looking only at the ED imaging studies, the successful import group underwent 18 percent fewer imaging exams (1.77 per patient, versus 2.16 for the failed import group).

Researchers also separated out the CT scans, showing that those with a successful CT image import were scanned 16 percent less than those with a failed import (1.19 scans versus 1.41). When comparing to CT scans only done in the ED, the figure was comparable, with a 15 percent difference between the groups.

Researchers attribute the decrease in imaging to fewer repeat studies.

The Brigham and Women researchers also compared CT scan rates to an historical control group of 254 ED patients who underwent scans between August 2007 and January 2008, prior to implementing CD import. For this group, they found that 29 percent (122 of 425) of CT scans done in the previous hospital were repeated in the ED after transfer. And 35 percent of those scans (43 of 122) may have been avoidable with CD import.


Sodickson and his colleagues argued that by transferring imaging studies along with the patient, there’s an associated decrease in healthcare costs and patient radiation exposure, and a potential increase in care efficiency. In order to further results, however, hospital systems need more robust methods to transfer the images. In this study, the 22 percent of CDs that failed to import were thought to be defective, using a non-DICOM format, or had other software incompatibility issues. They said that this points to the need for more standardized methods to transfer or access records between hospitals.