Highlights
- •After installation of the MR in the ED, there was increased use of the ED MR.
- •More patients admitted actually had a stroke, so LOS did not decrease.
- •Patients discharged after a negative MR were not at risk for stroke within 60 days.
- •ED MR yields improved efficiency and accuracy without under-diagnosing strokes.
Abstract
Purpose
We examined the impact of an MR scanner in the emergency department (ED) on ED length
of stay (LOS), hospital (H) LOS, hospital admission rate, hospitalization costs, and
ED re-presentation rate of patients presenting with stroke-like symptoms (SLS). We
hypothesized that the ED MR would increase efficiency of patient care.
Methods
The number of MRIs performed in the ED vs. inpatient setting, EDLOS, HLOS, hospitalization
charges, admission rate, discharge diagnoses, and 30–60-day ED re-presentation rates
were determined for ED patients with SLS six months before (2011) and after (2012)
ED MR installation.
Results
362 and 448 patients with SLS presented to the ED, and 196 and 176 patients were admitted
in 2011 and 2012 respectively. In 2011, 36 (18.4%) admitted patients, and, in 2012,
68 (38.6%) had MRIs in the ED, p < 0.001. In 2011, 74 (37.8%) admitted patients were diagnosed with ischemic stroke,
compared to 92 (52.3%) in 2012, p = 0.007. HLOS was longer and charges higher for patients with stroke. No patients returned
with a confirmed diagnosis of CVA or TIA within 0–60 days after being discharged from the ED with negative MR.
Conclusions
With the ED MR, more admitted patients 1) got scanned in the ED and 2) were diagnosed
with stroke. Because this led to more patients on the stroke service actually suffering
from strokes (and not other diagnoses), the overall HLOS and charges of patients presenting
with SLS were not reduced by ED MR screening. Discharge after a negative ED MR did
not incur risk of TIAs or strokes over the ensuing 60 days. Therefore, not only does a dedicated MR scanner in the ED aid in the acute diagnosis
of a CVA or other neurologic disorder, but it does so without the risk of under-diagnosing
TIAs or evolving strokes in the presence of a negative MRI.
Keywords
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Article info
Publication history
Published online: May 26, 2017
Accepted:
May 18,
2017
Received in revised form:
April 25,
2017
Received:
January 14,
2017
Identification
Copyright
© 2017 Elsevier Inc. All rights reserved.
