Evidence map›Paper›PMID 39501704›Full record

ArticleHealth services research2025

Variation in batch ordering of imaging tests in the emergency department and the impact on care delivery.

Jacob C Jameson, Soroush Saghafian, Robert S Huckman, Nicole Hodgson

Abstract read
In one paragraph

Article in Health services research, 2025. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Cited by 2 papers.

0numbers the graph read from it
0cells of the map it votes in
2citing papers in PubMed
–field-weighted citation impact
1 · What the graph read from it

What it found

Each row is one number read from the abstract, on the scale the paper reported it, with its interval. Left of the dashed line favours the treatment, right favours the comparator. Under each row is the sentence it came from. New to these charts? A ten-minute tutorial.

The abstract states no effect estimate the extractor could read, or names no intervention and outcome on the map, so this paper lights no cell and moves no belief. It is still indexed, cited and linked below.

2 · The registry

The trial behind it

Trials whose registry record cites this paper, or whose number appears in the abstract. A trial that started after this paper was published is citing it as background, not reporting it.

Neither the registry nor the abstract names a trial number. If this is a trial report, that itself is worth knowing.

3 · Its place in the literature

Who cites it

2 citing papers in PubMed.

  1. Article
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4 · The record

Corrections and comments

PubMed lists nothing against this paper. Absence here is not a guarantee, only a check that was made.

5 · Who and what money

Authors and funding

4 authors.

Jacob C JamesonHarvard Kennedy School, Cambridge, Massachusetts, USA.
Soroush SaghafianHarvard Kennedy School, Cambridge, Massachusetts, USA.ORCID https://orcid.org/0000-0002-9781-6561
Robert S HuckmanHarvard Business School, Boston, Massachusetts, USA.
Nicole HodgsonEmergency Medicine, Mayo Clinic, Phoenix, Arizona, USA.

Funding

Training Program in Comparative Effectiveness Research for Suicide PreventionT32MH125815 · NIMH · HARVARD UNIVERSITY D/B/A HARVARD SCHOOL OF PUBLIC HEALTH · PI MIGUEL HERNAN, MATTHEW K NOCK · 2022 to 2026
$1.2M
NIMH NIH HHS T32 MH125815
6 · The paper itself

Abstract

objectivesTo examine heterogeneity in physician batch ordering practices and measure the associations between a physician's tendency to batch order imaging tests on patient outcomes and resource utilization. STUDY SETTING AND

designIn this retrospective study, we used comprehensive EMR data from patients who visited the Mayo Clinic of Arizona Emergency Department (ED) between October 6, 2018 and December 31, 2019. Primary outcomes are patient length of stay (LOS) in the ED, number of diagnostic imaging tests ordered during a patient encounter, and patients' return with admission to the ED within 72 h. The association between outcomes and physician batch tendency was measured using a multivariable linear regression controlling for various covariates. DATA SOURCES AND ANALYTIC SAMPLE: The Mayo Clinic of Arizona Emergency Department recorded approximately 50,836 visits, all randomly assigned to physicians during the study period. After excluding rare complaints, we were left with an analytical sample of 43,299 patient encounters. PRINCIPAL

findingsFindings show that having a physician with a batch tendency 1 standard deviation (SD) greater than the average physician was associated with a 4.5% increase in ED LOS (p < 0.001). It was also associated with a 14.8% (0.2 percentage points) decrease in the probability of a 72-h return with admission (p < 0.001), implying that batching may lead to more comprehensive evaluations, reducing the need for short-term revisits. A batch tendency 1SD greater than that of the average physician was also associated with an additional 8 imaging tests ordered per 100 patient encounters (p < 0.001), suggesting that batch ordering may be leading to tests that would not have been otherwise ordered had the physician waited for the results from one test before placing their next order.

conclusionsThis study highlights the considerable impact of physicians' diagnostic test ordering strategies on ED efficiency and patient care. The results also highlight the need to develop guidelines to optimize ED test ordering practices.

Indexed as

Diagnostic ImagingEmergency Service, HospitalPractice Patterns, Physicians'AdultAgedArizonaFemaleHumansLength of StayMaleMiddle AgedRetrospective Studiesemergency departmenthealth care costsinstrumental variablesoperational effeciency

Identifiers

PMID39501704
PMCPMC11782078

What OpenQuestion holds

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Read under generation 80e0d062 · epoch 390. Bibliography from PubMed, PubMed Central and OpenAlex; grants from NIH RePORTER; trial links from ClinicalTrials.gov; estimates, votes and beliefs from the OpenQuestion graph.