Short-stay units: radiology’s test bed of the future

Short-stay units are a relatively new development in the war against healthcare costs. They are designed for patients who require observation and short-term intervention but (probably) not admission to the hospital.

Included in this group are patients who come to the emergency room with problems that require additional tests to determine whether the patients go home or stay. Naturally, how long it takes to make a decision determines whether a patient stays in one of these SSUs for less than a day, which is usually the breakpoint for these units, or longer. Some have extended their deadlines to 72 hours.

Research published June 10 in the Journal of Hospital Medicine documents that the success of an SSU depends on the availability of diagnostic tests performed and whether special consultations are needed, two factors are that getting tougher to control.

Initially conceived as a holding area for patients in need of relatively little medical care, their agendas are broadening. SSUs, typically located adjacent to emergency departments, increasingly are coming to include more complex cases, such as patients suspected of heart failure or out-of-control diabetes. It is hard to imagine a place better suited to be a proving ground for the medical imaging industry than these units.

Want to demonstrate the value of hand-carried ultrasound in triaging patients? Put several in an SSU and use them to identify patients who need more testing or can be released immediately because suspected problems are absent. Want to prove that coronary CTA is a cost saver? Document how this test can determine whether patients brought to these SSUs have cardiovascular disease.

These are just a couple of suggestions. Medical imaging is ripe with new ideas about how MR, CT, and PET might distinguish one disease from another. Take any hypothesis about how imaging technologies might improve efficiency or save money and test drive it in an SSU. Develop the ones that pan out and fine-tune the ones that don't until they do. Publish the results and use the data to support wider utilization and broader reimbursements.

And this approach doesn't have to stop with imaging modalities. RIS and staff management software can be leveraged to speed the exam process, just as PACS and teleradiology can be used to ensure they are read quickly and, if necessary, are given specialty attention.

In the study published last week, a lack of accessibility to diagnostic tests and the need for consultations were shown to be tightly associated with unsuccessful stays in SSUs. Patients who received expert consultation had a 52% chance of staying longer than they should in the SSU.

The researchers suggested that hospital staff should channel patients likely to need tests whose accessibility is limited or expert consultation away from SSUs so as to improve the chance these units will succeed. On the contrary, imaging vendors should target these SSUs and come up with plans to show how imaging and image management technologies can make help them reach their goals.

Handled correctly, SSUs could serve as test beds for the future. Their already highly selective patient populations can be managed to include more or less complex cases in the mix to test the ability of specific imaging modalities and information technologies to improve the efficiency of care.

Technologies proven effective here could blaze a new trail to more efficient and less costly healthcare. With the right approach and backing from vendors, medical imaging could lead the way.