Neurological Institute Outcomes

The Center for Neuroimaging is responsible for the interpretation of brain attack head CTs and CT angiography for the entire Cleveland Clinic health system. Guidelines for Primary and Comprehensive Stroke Centers dictate that a noncontrast head CT should be performed within 20 minutes of presentation and an interpretation should be provided to the responsible licensed independent practitioner within 45 minutes of presentation or within 20 minutes of the acquisition. The graph demonstrates consistent rapid turnaround of reports despite progressive increase in volumes during the past 5 years.

The overall mean for the Cleveland Clinic during 2023 across 22 hospitals with almost 7000 exams was 7.47 minutes. N = the overall number of brain attack head CTs performed for acute stroke. Note the increased time for Hospital 21 was due to only having 1 brain attack scanned at that site in 2023. The turnaround time for that single event was atypically delayed. Compliance for relaying the interpretation of brain attack scans to the responsible licensed independent practitioner within 45 minutes of presentation or within 20 minutes of acquisition was 97%.

The reporting of emergency room and STAT imaging studies is assigned a higher priority than routine inpatient and outpatient studies in the Center for Neuroimaging. Currently, median turnaround times indicate that emergency and STAT reports are generally completed in 20 minutes, inpatient reports in 30 minutes, and outpatient reports in 300 minutes.

The overall median turnaround times for outpatient and inpatient studies during 2023 were 70 and 30 minutes, respectively, while the median times for emergency room and STAT studies were ≤ 20 minutes. Outpatients scanned during Shift 2 (5 pm - 11 pm) are queued behind the STAT, emergency department, and inpatient studies for interpretation. As a result, some of these scans are not interpreted until the next day (Shift 1). Increasing after-hours ED, inpatient, and STAT examination volumes have exacerbated this over the last year.

While emergency room and STAT studies are assigned a higher priority, all outpatient reports are now generally available within 4 hours during 1st and 3rd shifts. The higher median for outpatients during shift 2 is somewhat longer as routine studies performed during the evening may be dictated first thing in the morning to accommodate the increasing demand and acuity of emergency and inpatient studies during the evening. Increasing after-hours ED, inpatient, and STAT examination volumes have exacerbated this over the last year.

The jump in turnaround time for 3rd shift in 2021 and 2022 is due to the increased number of outside hospital MRI and CAT scans, which are added to the PACS system for interpretation and timestamped at 12:00 am.

Median turnaround time for inpatient studies have otherwise remained < 45 minutes during the past 5 years for shifts 1 and 2 despite rising volumes. Even with the increases in the 3rd shift times, the turnaround times remain well below the Neurological Institute's goal of 6 hours.

Emergency room and STAT studies are assigned highest priority and the graph demonstrates turnaround times that are substantially below the institutional and national guidelines of 30 minutes.