ORIGINAL ARTICLE Clinical information available during emergency department imaging order entry and radiologist interpretation Tarek N. Hanna 1 & Saurabh Rohatgi 1 & Haris N. Shekhani 1 & Ishaan Amit Dave 2 & Jamlik-Omari Johnson 1 Received: 7 December 2016 /Accepted: 10 February 2017 # American Society of Emergency Radiology 2017 Abstract Objective The objective of this study was to evaluate the pro- portion of Emergency Department (ED) radiology examina- tions ordered or interpreted prior to a documented clinical assessment. Materials and methods We collected 600 retrospective con- secutive ED cases consisting equally of patients whose first ED imaging examination was computed tomography (CT), radiography (XR), or ultrasonography (US). For each patient, the following times were documented: ED arrival, ED depar- ture, ED length of stay (LOS), imaging order entry, image availability, radiology report availability, triage note, ED pro- vider note, and laboratory results. Results Mean age was 44.2, 66.5% female, and mean ED LOS was 326.2 min. ED LOS was longer for patients who received CT versus XR (343.9 vs. 311.3; p = 0.029). In 25.5% of XR, 10% of CT, and 8% of US cases, the imaging exam was completed before the ED provider note was started. In 20.5% of XR, 6.5% of CT, and 6% of US cases, the radiologist did not have the ED provider note available prior to complet- ing their diagnostic interpretation. In 33.4% of all cases and 57.5% of XR cases, incomplete clinical documentation (triage note, provider note, lab results) was available during radiology report creation. CT and US exams more frequently had clinical data available prior to radiologist interpretation than XR (p< 0.0001). Radiologist turn-around-time was unaffected by clinical information availability. Conclusion Eight percent of ED CT and 10% of ED US ex- aminations were ordered and completed before documented clinical assessment. Thirty-three percent had incomplete clin- ical assessment performed prior to image interpretation. Further investigation is needed to determine impact on inter- pretation accuracy. Keywords Emergency department . Turn-around time . History . Clinical information . Workflow . Radiology Introduction Emergency department (ED) visits in the USA have increased at nearly twice the rate of population growth, yet the number of ED facilities has been declining [1–6]. These oppositional trends contribute to ED overcrowding, restrict care access, and worsen clinical outcomes [2, 3, 7]. Advanced imaging in- creased 140% from 2001 to 2008 during a period in which occupancy increased by only 27%, and this increased imaging utilization is one contributor to ED crowding [1]. Against this backdrop of growing patient volumes, managing ED length of stay (LOS) is essential to improving throughput [8], yet ED LOS is increasing between 3.5 and 13.9% per year depending on the patient subgroup [3]. Since imaging is a rate-limited step in certain patients, shortening ED LOS requires curtailing the growth of ad- vanced ED imaging and improving throughput. Targeted so- lutions include choosing the right imaging examination, elim- inating unnecessary imaging, improving imaging workflow, and shortening diagnostic radiologist turn-around-time (TAT) [ 9–11]. These radiology specific measures should be * Tarek N. Hanna tarek.hanna@emory.edu 1 Division of Emergency Radiology, Department of Radiology and Imaging Sciences, Emory University Midtown Hospital, 550 Peachtree Road, Atlanta, GA 30308, USA 2 Rollins School of Public Health, Emory University, Atlanta, GA 30322, USA Emerg Radiol DOI 10.1007/s10140-017-1488-4