Failure of CT sharing in a large municipal hospital.

Harlem Hospital Center lacks computed tomography (CT) facilities. During 1979 it attempted to share the CT facilities of two other institutions. Retrospective analysis reveals that under this arrangement only a small percentage of Harlem patients needing CT obtained it. Among patients recommended for CT, 252 of 1528 without trauma and six of 342 with trauma received it. In some instances there were difficulties in moving patients between hospitals. If transportation had been optimal, however, the other hospitals, because of their own needs, would have been unable to provide Harlem Hospital with more than a third of the CT scans requested. Furthermore, even if unlimited opportunities for scanning had been available, patients whose need for CT seemed most urgent--the very ill--would have been unable to receive it; of 163 patients who died without receiving CT as recommended, 93 were too sick or deteriorating too rapidly to be moved to the CT facilities. We conclude that CT cannot be effectively shared by large acute-care hospitals.