Direct to Radiology Emergency Avoidance Management (DREAM): A Quality Improvement Research Study on Reducing Emergency Department Overcrowding.

BACKGROUND: Primary-care referrals to the emergency department (ED) for advanced imaging, often due to workflow and insurance barriers, contribute to unnecessary ED visits and ED overcrowding. Redirecting lower-acuity patients to outpatient evaluation may reduce treatment time and ease ED burden. This pilot study evaluated a Direct-to-Radiology Emergency Avoidance Management (DREAM) program for outpatients with urgent complaints. The authors hypothesized that DREAM patients would have a shorter time from arrival to imaging report finalization (AIRF) than comparable ED patients who underwent similar computed tomography (CT) examinations and were discharged without requiring higher-level care. METHODS: In this retrospective study, primary care patients requiring same-day CT imaging for urgent complaints (defined as conditions requiring timely medical evaluation to prevent clinical deterioration but not necessarily requiring immediate life-saving intervention) were enrolled in the DREAM program and compared to ED patients evaluated during the same period who underwent similar urgent CT examinations and did not require admission/escalation of care. The primary outcome was AIRF (minutes). Ordering outpatient providers and involved radiologists completed a perception survey. RESULTS: A total of 155 patients (median age 61 years) in the DREAM group were compared with 4,182 ED patients (median age 59 years). AIRF for DREAM outpatients (median 156 minutes, interquartile range [IQR] 130-196 minutes) was significantly shorter than the ED cohort (median 305 minutes, IQR 158-484), p < 0.001. Imaging revealed positive findings in 62/155 (40.0%) of DREAM patients; 9 of these were referred to the ED within 48 hours, while the remainder were managed conservatively as outpatients. CONCLUSION: The DREAM program safely delivered appropriate care for most patients while avoiding unnecessary ED visits and improving efficiency. DREAM may alleviate ED overcrowding and optimize healthcare resource use.