1. Outside Imaging in Emergency Department Transfers Jonathan Opraseuth MD Stephen Ledbetter MD MPH Aaron Sodickson MD PhD Emergency Radiology, Brigham and Women’s Hospital, Harvard Medical School Boston, MA

2. Multiple clinical teams able to view imaging studies Radiologists able to review on familiar workstations No fear of losing CD Decreased rate of subsequent imaging Streamlined Patient Care

3. ED transfer patients with CD import attempt Successful Import Unsuccessful Import Pre- implementation Cohort Compared Subsequent Imaging - All study types, and CT specifically - All locations, and ED specifically Repeat and Additional Imaging

4. ED transfer patients with CD import attempt Successful Import Unsuccessful Import Pre- implementation Cohort 1487 patients 2/09 – 8/09 78% (n=1161) 141 hospitals 22% (n=326) 254 patients

5. 50% contained more than 1 study 30% contained more than 1 modality (usually x-ray and CT)

7. 29% decrease (p=0.0004) Avg # CT/patient in 24 hrs

8. 1152 CT scans successfully uploaded in 793 patients 16% (n=185) repeated within the ED 29% repeated in the pre-implementation cohort Repeat CT constituted 19% of all CT scans subsequently performed within the ED 41% pre-implementation cohort

9. Importing outside imaging to PACS  decreased imaging utilization Reduced repeat imaging 17% for all imaging 16% for CT Decreased Radiation Exposure Decreased Excess Costs