The problem wasn't the time it took to perform the clinical tests and interventions, but the frequency of the tests and treatments, researchers found. While CT scans, MRIs or ultrasonography increased significantly, so did the volume of procedures, such as performing three or more diagnostic tests on single patient and issuing two or more medications.
The frequency and wait times for those patients in the ED increased from 26% to 76%, and the combination of all of the "routine" testing exceeded the crowding and delays wrought by imaging work, they said.
"These are things we do on an everyday basis," Pine told HealthLeaders Media, referring to the routine tests. The impact on ED crowding and waiting "was a surprise," he added.
Ironically, it is possible that innovations intended to speed ED throughput—such as authorizing the early ordering of blood testing, intravenous lines and radiographic testing at triage—may also be slowing down ED operations, Pines says.
All those clinical tests, which the report described as "greater treatment intensity," may reflect several factors, including the practice styles of physicians geared to order more testing, according to Pines. That could be pinned on a variety of issues that could range from docs seeking higher quality care, but also those practicing defensive medicine, or pursuing financial incentives.