Damian McNamara

October 25, 2013

SEATTLE — Emergency physicians ordered significantly fewer imaging tests for patients transferred from an acute care hospital within their accountable care organization than for patients transferred from an outside facility, according to a study conducted at 2 trauma centers.

The overall cost of hospitalization was also lower for patients transferred internally.

"Within these affordable care organizations, there are inherent efficiencies that could save millions of dollars per year," said Brian Geyer, MD, from Brigham and Women's Hospital in Boston. Improved image sharing by institutions in the same organization makes this greater efficiency possible, he told Medscape Medical News.

Dr. Geyer presented the findings here at the American College of Emergency Physicians (ACEP) 2013 Scientific Assembly.

His team assessed 7696 trauma patients transferred to the level 1 trauma centers at Brigham and Women's Hospital and Massachusetts General Hospital.

Electronic images were available for the nearly 15% of patients transferred from a facility within the accountable care organization during the 5 years of the study.

Decreases emerged across the board. There were significantly fewer computed tomography (CT), magnetic resonance imaging (MRI), and ultrasound images ordered for the 1143 patients who came from an accountable care organization.

Table. Imaging Studies Ordered per Transferred Trauma Patient

Images Accountable Care Organization, n External Facility, n P Value


3.00 3.37 <.001


0.44 0.52 .025


0.11 0.13 .002


3.55 4.02 .003


The increased use of imaging in the emergency department has come under scrutiny because it plays a prominent role in rising healthcare costs, according to the researchers. Efficiencies could help ease these costs.

In a related study, Dr. Geyer presented data on the overall cost of hospitalization associated with the same cohort of trauma patients.

Length of hospital stay was similar for accountable care organization facilities and external facilities (3.9 vs 3.7 days; P = .095). However, after adjustment for differences in diagnoses, the cost of hospitalization was 7% lower for accountable care organizations.

There were some differences between groups. Time from injury to arrival at the level 1 trauma center was shorter in the accountable care group than in the external group (5.03 vs 5.44 hours; P =.0011). In addition, accountable care patients were significantly older than external patients (57.1 vs 53.6 years; P < .001).

In the accountable care group, the use of 7 specific scans — head CT, maxillofacial or facial area CT, chest CT, abdomen CT, pelvis CT, spine and extremity CT, and spine MRI — was significantly lower (P < .001).

Despite difference in transfer time, demographics, and diagnoses, injury severity scores at presentation were not significantly different in the accountable care and external groups (12.3 vs 12.0; P = .129).

The researchers "did a nice job," said Eric Legome, MD, from State University of New York (SUNY) Downstate Medical Center in New York City. However, he questioned why the costs were different between groups.

"Is it a single factor? Are they just redoing things for outside transfers, or are they a different type of patient?" asked Dr. Legome, who moderated and led a large group around the poster discussion session. Future research could evaluate significant differences between these patient groups, he noted.

The implications of the findings could extend beyond the patient population studied, Dr. Geyer pointed out. "We looked at traumatic injuries. It's beyond the scope of our data, but hopefully this study will compel others to look at nontraumatic injuries."

Dr. Geyer and Dr. Legome have disclosed no relevant financial relationships.

American College of Emergency Physicians (ACEP) 2013 Scientific Assembly. Abstracts 163 and 176. Presented October 14, 2013.


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