STAT Semantics

An incredulous colleague felt the need to reach out and vent to me this past week: A hospital he covers had made “Super-STAT” an official part of their workflow.

The term is probably familiar to any readers who have been working in healthcare for more than a little while. At first blush, I think most have the same reaction to it: “What’s the point?”

STAT means something needs to happen right away. I’ve never actually been clear on why folks feel the need to capitalize the entire word. It’s not an acronym, it’s short for statim, latin for “immediately.” Still, everyone else does the all-caps thing, so who am I to differ? STAT it is.

If STAT means immediately, a reasonable person might wonder how “super-STAT” could be any faster. Until somebody figures out how to manipulate the flow of time, STAT is, by definition, as fast as it gets.

A definition that doesn’t long survive contact with the real world, unfortunately. Talk about immediacy all you want, but resources are limited. People and objects can only move so fast and do so much.

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So a bunch of referring clinicians declare their orders for imaging to be STAT, but the final common pathway—getting patients to, in, and out of the imaging equipment—is a bottleneck. As is getting those studies interpreted, once they’re done. In that chain of events, only the STAT-declaration is instantaneous, effortless, and without pushback or other resistance.

Effectively, the only reason an order isn’t STAT is the forbearance of the referrer. Maybe you’ve had the good fortune to work in an institution where there is some mechanism to discourage an “if I order it, it’s STAT” mentality. I certainly haven’t. Rather, I’ve worked in some facilities where certain referrers, as a sort of VIP status, get all their exams treated this way.

Small wonder, then, that we wind up with a perpetual traffic-jam of STATs to be done. But y’know what happens when everybody is supposed to go first? Nobody does. STAT becomes the new routine. All other categories a facility might have—Emergent, Urgent, Routine…they’re all jockeying to go last, no matter what they’re called.

So, at some point, a clinician gets a bright idea: This patient, right here, is a “real” STAT. Not like all those other crying-wolf STATs that litter the medical landscape. And, either verbally or actually in writing, s/he declares the case to be “Super-STAT.” Somehow, that’s supposed to make all the other STATs move aside.

It’s pure semantics. Any other clinician aware of the situation could immediately respond, “Oh, yeah? Well, those 18 STAT patients of mine? They’re all super-STAT too.” And, indeed, the trick of ordering a super-STAT catches on.

The poor radiology techs and clerks have no authority to do anything about this. What are they going to do, stick their necks out and argue with referrers? Simpler and safer to take the path of least resistance and do what they’re told. “Sure thing, doc, you say your patient is more STAT than all those other ones, go ahead and bring him in.”

I can see an institution feeling the need to make official policy governing this stuff. But it amazes me that the choice would be to add fuel to the fire, and make “Super-STAT” a new top-priority category. Does anybody really think that will fix things? How long will it take the “If I order it, it’s STAT” referrers to change into “If I order it, it’s super-STAT” referrers? Once the new term catches on, who would bother with a regular STAT? All that would do was make sure your patients were in the front ranks of the back of the line.

When I size up a problem, I focus on what would take the least amount of time, effort, resources, etc., to fix. In this case, I see two levers that can be moved. Inflow (referrers’ ability to make STAT orders whenever they please), and outflow (a rad department’s ability to get patients imaged, and, then, to have those images interpreted).

To “fix” the outflow, one might try finding improved efficiencies…but let’s be honest, that horse has been flogged nearly to death over the years. Departments trying to keep up with reimbursement cuts and the like have already done everything they can think of. At this point, further improvement usually involves expensive things like buying more scanners, hiring more personnel, contracting out some of the reads, etc.

Or, we could fix the inflow, and put limitations on how referrers throw around the word STAT. Quick, cheap, and easy.

Doesn’t it make more sense for an institution to address the excessive use of STAT orders? If they’ve grown unchecked to the point that the term has been devalued, maybe it’s time to rein that in. Make it a part of utilization review…or, if it already is, examine whether it’s being taken seriously enough.

One mechanism would be to put the referrers on notice: Their STATs are being tracked. Monthly, quarterly, whatever—send them stats on their STATs. Dr. X, 80 percent of your orders for imaging are STATs; why is that? You don’t work in the ER, and you don’t cover the ICU. Others in your department average 30 percent. If you can’t bring that number down, we might need you to come in for a meeting where we go through them, case by case, and discuss why you thought they were all so urgent.

Follow Editorial Board member Eric Postal, M.D., on Twitter, @EricPostal_MD.