E2461. Impact of COVID-19 "Safer At Home" Order on Radiology Utilization by Patient Location, Specialty and Appropriateness
  1. Evan Raff; Olive View UCLA Medical Center
The COVID-19 pandemic has had an unprecedented impact on healthcare system operations and on radiology departments in particular. The goal of this project is to evaluate the impact of the COVID-19 pandemic and resulting “Safer At Home” order on provider ordering behavior to determine how the pandemic has impacted radiology utilization, indication and appropriateness by patient care location. In addition to evaluating the volume of study orders, this project aims to determine the impacts of the pandemic on clinical presentation, indication and appropriateness of imaging studies using clinical decision support (CDS) rules. We would like to assess the magnitude of this change based on patient care location (emergency department, inpatient and outpatient) to gain insights for managing utilization during and after the COVID-19 pandemic.

Materials and Methods:
A retrospective review of radiology orders, indications and appropriateness will be performed for studies with the County of Los Angeles Department of Health Services system, using the data derived from the DHS electronic medical record ORCHID and ED system and the imaging clinical decision support tool. Data on consults from the eConsult system will also be evaluated during the same period. Data will be anonymized, aggregated and analyzed for evidence of trends in radiology utilization and clinical presentation. Chi-square and ANOVA multifactor analysis will be used to evaluate the impact of the pandemic response on resulting radiology and clinical utilization as compared to historic baselines.

Total radiology orders decline by an average of 40% following the “Safer At Home” order. Outpatient volumes declined by 67%, emergency department volumes declined by 21%, and inpatient volumes declined by 13%. The biggest impact on radiology subspecialty was in dexa and breast imaging which saw a decrease in volumes of 88% and 80%, respectively. The least impacted areas were Body/CT imaging and IR which saw only a 29% and 26% decline, respectively. In comparison, overall outpatient consults decreased by an average of 53%, with the largest impacts seen in gastroenterology, optometry/ophthalmology, gynecology and nutrition. Emergency department visits declined by an average of 44%.

The COVID-19 “Safer At Home” order resulted in a significant decline in radiology ordering utilization, outpatient consultations and ED visits. There was a disproportionate impact in the outpatient setting, especially on screening and other nonessential imaging. This mirrors the impact that the order has had on clinical services, as reflected in outpatient consult volumes, with larger declines in specialties with high screening rates, including in gastroenterology, optometry/ophthalmology, and gynecology. Emergency department visits, which would typically be considered urgent/essential, also demonstrated significant decline, indicating that the “Safer At Home” was also reducing utilization of some essential services or that these visits/orders may have not been truly urgent.