Streamlining pathways for minor injuries in emergency departments through radiographer-led discharge

Abstract

Diagnostic imaging services are essential to the diagnosis pathway for many patients arriving at hospital emergency departments with a suspected fracture. Commonly, these patients need to be seen again by a doctor or emergency nurse practitioner after an X-ray image has been taken in order to finalise the diagnosis and determine the next stage in the patients’ pathway. Here, significant waiting times can accrue for these follow-up consultations after radiographic imaging although the vast majority of patients are discharged. Research evidence from pilot studies suggests that patients with minor appendicular injuries could be safely discharged by a suitably qualified radiographer directly after imaging thereby avoiding queues for repeated consultation. In this study, we model patient pathways through an emergency department (ED) at a hospital in the South West of England using process mapping, interviews with ED staff and discrete event simulation (DES). The DES model allowed us to compare the current practice at the hospital with scenarios using radiographer-led discharge of patients directly after imaging and assess the reduction in patients’ length of stay in ED. We also quantified trade-offs between the provision of radiographer-led discharge and its effects, i.e. reduction in waiting times and ED workload. Finally, we discuss how this decision support tool can be used to support understanding for patients and members of staff.