JACR: Advanced medical imaging = reduced inpatient stays, costs
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In relating the early use of advanced imaging to length of hospital stay, Juan Carlos Batlle, MD, and colleagues from Massachusetts General Hospital (MGH) in Boston found that in addition to the decrease in hospital stays, early imaging may also reduce the high costs associated with hospitalization.
Batlle and colleagues found that inpatient costs represent approximately 18 percent of total healthcare insurance premiums paid and continue to rise approximately 8 percent annually.
“The stable growth of hospital costs despite marked increases in imaging costs has led to the observation that the increased use of modern imaging has been associated with a decrease in other costs of hospitalization, such as length of stay,” they wrote.
The researchers selected 10,005 admissions (30.1 percent) of the 33,226 admissions to MGH in 2005 that included one advanced imaging study (CT, MRI or nuclear scintigraphy) during the period from one day before admission through discharge for inclusion in their study. The length of stay and using the date of the first advanced imaging study performed relative to date of admission (date of service), as well as the residual length of stay (length of stay minus date of service) of each admission were calculated.
The authors compared the average length of stay of patients with early imaging (before or on the same day of admission) to the patients who underwent later imaging.
“Results showed that in comparison the length of stay was significantly shorter for those imaged on the day before or day of admission vs. day one or two for all admissions of at least three days,” wrote the authors.
Further analysis of specific patient subgroups also found that the average length of stay for abdominal CT exams was 8.4, compared to 9.7 days with later scanning and for neurologic MRI exams, 7.6 compared to 8.7 days. A “statistically significant positive correlation” was also noted between length of stay and date of service for all admissions, including CT, chest CT, nuclear scintigraphy examination types and abdominal ICD-9 codes, Batlle said.
Noting several limitations to their study, including the involvement of a single institution and not stratifying patients according to clinical severity, service or means of admission to the hospital, the researchers estimated the average cost of a hospital stay as $2,129 per day, which means that the estimated decrease in cost for the one-year period analyzed in their study associated with an average one day reduction in length of stay is approximately $2,129 per admission.
“Although the study design does not establish cause and effect, our results suggest that early imaging could expedite inpatient care and discharge in certain types of patients, but they do not imply that automatic ordering of imaging should replace clinical judgment,” said Batlle.