Decreasing length of stay with emergency ultrasound examination of the gallbladder

M Blaivas, R A Harwood, M J Lambert
Academic Emergency Medicine: Official Journal of the Society for Academic Emergency Medicine 1999, 6 (10): 1020-3

OBJECTIVE: To determine whether patients who received emergency screening ultrasound examinations (ESUEs) of the gallbladder by emergency physicians (EPs) have a shorter ED length of stay (LOS) than do those receiving ultrasound studies from radiology.

METHODS: A retrospective chart review from July 1995 to August 1998 identified 1,242 patients who received gallbladder ultrasound examinations. Seven hundred fifty-three patients received ESUEs by EPs of varying levels of ultrasound experience. Four hundred eighty-nine patients received gallbladder ultrasound examinations from radiology, and were not scanned by EPs. The LOSs of the two groups were compared. Significance was evaluated using a two-tailed t-test.

RESULTS: When patients received an ESUE by an EP, the median LOS was 7% (22 min) less than that for those who received an ultrasound examination by radiology (p = 0.017; 95% CI = 4 min to 41 min). When evaluated by disposition, patients discharged home and scanned by EPs had their median LOSs shortened by 11% or 32 minutes (p = 0.02; 95% CI = 5 min to 55 min). When evaluated by time of day, patients who presented after hours (6 PM-6 AM) and were scanned by EPs spent 15% (52 min) less time in the ED (p = 0.0002; 95% CI = 26 min to 89 min). Those who were seen after hours and discharged home had their LOSs shortened by 20% (1 hr, 13 min, p = 0.001; 95% CI = 28 min to 1 hr, 56 min).

CONCLUSIONS: In a teaching hospital with a residency program, ESUEs decrease ED LOS for these patients. The difference was most apparent for patients presenting after hours.

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