The impact of introducing a no oral contrast abdominopelvic CT examination (NOCAPE) pathway on radiology turn around times, emergency department length of stay, and patient safety

This investigation evaluates the impact of the no oral contrast abdominopelvic CT examination (NOCAPE) on radiology turn around time (TAT), emergency department (ED) length of stay (LOS), and patient safety metrics. During a 12-month period at two urban teaching hospitals, 6,409 ED abdominopelvic (AP) CTs were performed to evaluate acute abdominal pain. NOCAPE represented 70.9 % of all ED AP CT examinations with intravenous contrast. Data collection included patient demographics, use of intravenous (IV) and/or oral contrast, order to complete and order to final interpretation TAT, ED LOS, admission, recall and bounce back rates, and comparison and characterization of impressions. The NOCAPE pathway reduced median order to complete TAT by 32 min (22.9 %) compared to IV and oral contrast AP CT examinations (traditional pathway) (P < 0.001). Median order to final TAT was 2.9 h in NOCAPE patients and 3.5 h in the traditional pathway, a 36-min (17.1 %) reduction (P < 0.001). Overall, the NOCAPE pathway reduced ED LOS by a median of 43 min (8.8 %) compared to the traditional pathway (8.2 vs 7.5 h) (P = 0.003). Recall and bounce back rates were 3.2 %, and only one patient had change in impression after oral contrast CT was repeated. The NOCAPE pathway is associated with decreased radiology TAT and ED LOS metrics. The authors suggest that NOCAPE implementation in the ED setting is safe and positively impacts both radiology and emergency medicine workflow.