A direct-to-radiology program at UMass Memorial Health called DREAM cuts the time from patient arrival to CT imaging results from 305 minutes to 156 minutes by routing urgent primary care patients directly to CT scans instead of the emergency department, reducing unnecessary ED admissions while maintaining safe, appropriate care.
- The DREAM program reduced median arrival-to-imaging report finalization time from 305 minutes to 156 minutes, a nearly 50% reduction compared to standard ED pathways
- 155 urgent patients were routed directly to radiology for prioritized CT imaging between December 2022 and September 2023, with results communicated directly to ordering providers
- Only 9 patients (6% of the cohort) required ED referral within 48 hours, while 53 were managed conservatively as outpatients, demonstrating safety and appropriateness of the direct-to-CT approach
- All 11 ordering providers reported satisfaction with turnaround times and indicated they would recommend the program, suggesting strong clinical acceptance
- This model addresses ED overcrowding and unnecessary admissions by creating an alternative pathway for patients requiring urgent imaging but not emergency-level care
Bypassing the emergency department (ED) and routing urgent primary care patients directly to CT scans can cut time from arrival to imaging results by nearly half, a team at UMass Memorial Health in Worcester has reported.
The finding is from an analysis of a pilot project called the Direct-to-Radiology Emergency Avoidance Management (DREAM) program and suggests a dedicated direct-to-CT pathway can safely deliver appropriate care and alleviate ED overcrowding, noted lead author Behroze Adi Vachha, MD, PhD, and colleagues.
“Ambulatory primary care practices frequently refer patients to the ED when CT imaging is required, particularly when clinic workflow constraints or insurance authorization barriers exist,” the group wrote. “This contributes to unnecessary ED admissions for patients who do not require emergency-level care.” The study was published August 6 in The Joint Commission Journal on Quality and Patient Safety.
While standard ED fast-track systems can reduce wait times for low-acuity patients, they often require additional staffing, limiting scalability, the authors noted. To assess an alternative approach, physicians at the participating outpatient clinic ordered CT exams in Epic for 155 patients with urgent complaints between December 2022 and September 2023. These patients went directly to radiology for prioritized CT, with results then communicated directly to the ordering provider.
For the analysis, outcomes were compared with 4,182 ED patients who underwent similar CT examinations during the same weekday daytime period and were discharged. The primary outcome was time from arrival to imaging report finalization (AIRF).
According to the results, DREAM patients achieved a median AIRF of 156 minutes versus 305 minutes for ED controls (p < 0.001). Among DREAM patients, 62 (40%) had positive imaging findings, with nine (6% of the full cohort) subsequently referred to the ED within 48 hours. The remaining 53 were managed conservatively as outpatients. All 11 ordering provider survey respondents reported satisfaction with the turnaround time and said they would recommend the program.
“To the best of our knowledge, this is the first reported pilot of an expedited outpatient direct to CT imaging program designed to promote ED avoidance,” the researchers wrote.
The authors noted that expansion to additional referring centers and larger patient volumes is ongoing. Future studies will evaluate the program's impact on patient length of stay, final disposition, and cost reductions, they added.
The full study is available here.
