Testing

Approximately 70%-75% of patient evaluations are completed in the ED. Additional testing, however, can be a significant source of delay in patient disposition. MRI, ECHO, Stress Testing, USN, CT scans, etc. can all be rate limiting steps in the completion of a patient’s evaluation. Often, a hospital facility performs studies for both hospitalized patients and outpatients, and finds itself giving priority to scheduled outpatients, causing everyone else to wait. This may be due to several reasons: reimbursement, control of a scheduled population, and easier testing are chief culprits. When this occurs, the hospitalized patient is processed later, delaying the decision-making process, which delays consult acquisition and ultimately is reflected in an increased LOS as a result.

Every department needs to work closely with the hospital to make sure hospitalized patients are prioritized for testing. The team-based care provider must be able to communicate to the testing department what priority should be given. Obviously, a life-threatening test takes absolute priority but after this comes “the day of discharge-dependent testing,” tests whose results will allow a disposition decision to be made, especially if the disposition decision is discharge.

Day of Discharge-Dependent testing is an important component of the team-based care model. It should also be well established throughout the hospital community that not every test has to be top priority. Many tests can be accomplished on an outpatient basis, for example, and need not bump a discharge decision on the priority list. The more everyone understands this and communicates as a team, the better the entire system will work.

In January of 2020, CMS instituted a mandated appropriate use imaging program. This program will require physicians ordering expensive testing on outpatients to get prior approval for the test. The use of an algorithm to determine appropriateness of the test will be required. Starting in 2021, if a physician fails to do this, the test will not be paid for by CMS [39].