Operational Excellence Drowning in STAT: A Crisis We Must Fix February 25, 2026 - Kernesha Weatherly

 

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In today’s world, immediacy is everything. From on-demand entertainment to same-day shipping, society as we know it, has now conditioned itself to expect instant gratification. Gone are the times when you had to wait your turn to use the family landline, hoping the neighbor or your sibling would finally hang up so you could make a call.

Remember sitting by the radio, cassette tape ready, waiting for your favorite song to play so you could record it, only for the DJ to talk over the intro? Or rushing to the mailbox to see if your pen pal, a faraway friend, or even a love interest had written you back? Before email and text messages, communication wasn’t instant; it was an exercise in patience.

These moments, once a natural part of daily life, have all but disappeared, replaced by a culture of now. While convenience has its perks, there was something uniquely satisfying about the anticipation of waiting. Something today’s instant world may never quite understand.

This mentality has seeped into healthcare, where the word STAT has become less about true urgency and more about an expectation of immediacy, regardless of medical necessity. Nowhere is this more apparent than in the field of Imaging, where an overabundance of STAT imaging orders is stretching departments to their limits. But was this really the intended goal?

The Origins of STAT in Healthcare

​The term STAT is derived from the Latin word statim, meaning immediately². Its usage is primarily associated with the medical field, where it denotes urgency in executing orders or procedures.

The earliest documented use of STAT in a medical context dates back to 1875, as noted by W. H. Griffiths. In his 1875 publication, “Lessons on Prescriptions and the Art of Prescribing,” Griffiths provided guidance on the principles of writing medical prescriptions³. Within this context, he introduced the abbreviation STAT to signify that a medication should be administered immediately⁴. This inclusion reflects the medical practice of the time, emphasizing the importance of clear and precise instructions for timely patient care.

This was necessary in the 19th century, as the process of filling prescriptions was more time-consuming than today. Pharmacists, known as apothecaries, often compounded medications by hand. This meticulous process often led to delays, especially if the pharmacy was busy or if the medication required complex preparation.

The term STAT has since become a standard directive in healthcare settings, underscoring the necessity for urgent action in instances where delays could mean the difference between life and death.

In mass casualty incidents (MCIs), the effective allocation of limited medical resources is critical to maximize survival and outcomes. This has necessitated a structured approach to prioritize patient care, commonly known as triage. One widely adopted triage method is the Simple Triage and Rapid Treatment (START) system, developed in 1983 by Hoag Hospital in Newport Beach, California, in collaboration with the Newport Beach Fire Department. It categorizes patients into four groups based on the urgency of their medical needs:

• Immediate (Red): Patients requiring immediate life-saving interventions.
• Delayed (Yellow): Patients whose treatment can be postponed without immediate threat to life.
• Minor (Green): Patients with minimal injuries who can self-ambulate.
• Expectant (Black): Patients who are deceased or have injuries so severe that survival is unlikely².

This stratification enables responders to focus efforts on those most likely to benefit from immediate care, thereby optimizing resource utilization. The system categorizes patients based on their ability to walk, respiratory status, perfusion, and mental status, enabling first responders to efficiently allocate medical resources. Since its development, START has been widely adopted and modified for use in various emergency and disaster response settings worldwide⁵.

In terms of STAT imaging orders, these were historically reserved for trauma cases, acute strokes, or conditions where diagnostic delays could compromise patient outcomes. However, the widespread use of STAT in today’s inpatient (and outpatient) setting has deviated significantly from its original intent and does not follow the same prioritization that the START system offers. What was once reserved for the truly urgent has now become routine, diluting its significance and effectiveness.

This shift mirrors a broader trend in healthcare where immediacy has become an expectation rather than an exception. The advent of electronic medical records (EMRs) and computerized physician order entry (CPOE) has made ordering tests as simple as a few clicks. Unlike the days when a provider had to physically call the imaging department or walk the paper order to the department and justify the urgency, today’s digital systems allow STAT requests to be made with little friction.

This change isn’t confined to imaging. Every service department, in direct patient care or not, is feeling this shift. The impact extends well beyond workflow inefficiencies — it creates a false sense of urgency, stretching resources and leading to unintended consequences.

Imaging departments are inundated with STAT requests, leaving truly critical cases competing for attention. Technologists and radiologists are expected to triage orders that, in many cases, don’t require immediate attention, delaying those that do. Radiologists must constantly prioritize, adding to their cognitive load.

This issue is further exacerbated by external pressure on imaging from those who expect near instant turnaround times, often without considering the many factors that impact exam completion. Imaging departments are often cited or criticized when exams are not completed within time frames deemed appropriate by those outside the field. However, these assessments rarely reflect the full clinical picture. In many cases, delays occur due to factors beyond imaging’s control.

For example, an exam may be ordered, but due to existing policies, there is a pending pregnancy test that is needed before contrast can be safely administered. Only after identifying that the patient is perhaps dehydrated, the clinical team decides to perform a blood draw versus sequestering a urine sample, further increasing the turnaround time.

A CT scan may be delayed because the patient needs an IV, and access is challenging. An MR may be delayed due to internal metal devices that haven’t been interrogated. There are times when the clinical team is actively assessing the patient at the moment of transport, making it impossible to move forward. Patients may also be in another exam, something that isn’t always communicated in real time. These are necessary steps in patient care, yet they are often overlooked when someone files a complaint or escalates a delay on behalf of imaging.

These patterns reflect a deeper issue in modern healthcare, which is the blurring of urgency and convenience. Healthcare systems have adapted to a culture where waiting, even when clinically appropriate, is often scrutinized. However, the expectation of instant results doesn’t inherently equate to better care. Rather, it creates a bottleneck, where true emergencies are forced to compete with cases that, a decade ago, would have been managed within routine workflows.

Imaging has always been a critical pillar of patient care, but it is not an isolated service. It is deeply intertwined with the broader healthcare continuum. If the system continues to prioritize immediacy over clinical necessity, the result isn’t just inefficiency; it’s a dilution of urgency that could ultimately compromise the very care we are all working to provide.

As healthcare continues to evolve, the question remains: How do we redefine urgency in a system where immediacy has become the default expectation?

The STAT Mentality: A Societal Shift

The rise of immediacy culture is everywhere, a shift that has influenced how providers, nurses, and hospital administrators perceive urgency. Further, the absence of clear prioritization leads to inefficiency, delays for patients who need imaging most, and frustration across the system.

The concept of priority loses its meaning, efficiency collapses, and true emergencies become lost in the noise. If everything is labeled STAT, then nothing is truly STAT. This overuse has profound effects on imaging infrastructure:

• Workflow Disruptions: Imaging departments must continually rearrange schedules to accommodate STAT orders, often pushing routine (but still essential) exams further down the queue.
• Technologist and Radiologist Burnout: Constantly shifting gears to accommodate STAT exams creates stress, fatigue, and a decrease in job satisfaction.
• Devaluation of Urgency: True STAT exams may be delayed because of an influx of unnecessary STAT requests.
• Increased Errors: Rushed imaging leads to potential quality issues, which can compromise patient care.
• Strain on Infrastructure: Equipment wear and tear, scheduling inefficiencies, and extended patient wait times compound the problem.

The Multi-Disciplinary Responsibility

Unlike a provider making clinical decisions at the bedside, imaging is reactive by design, fulfilling the needs of ordering providers rather than dictating them. Yet, in a system increasingly shaped by immediacy and convenience, imaging is being held accountable for a tidal wave of STAT requests they did not generate. Attempting to solve this problem within imaging alone would be like asking a restaurant kitchen to limit customer orders during a dinner rush without any ability to manage what’s printed on the tickets.

Clinical decision support (CDS) was designed to guide ordering providers by promoting evidence-based imaging and reducing unnecessary exams. While the intent was to improve ordering habits outside of imaging, its impact has landed squarely on imaging’s shoulders⁶.

Instead of deterring overuse, CDS has added layers of documentation without truly changing behavior. When an ordering provider selects a low-utility study, the CDS system may simply require an additional justification checkbox rather than prompting a meaningful reconsideration. The end result? The exam still gets ordered, the expectation for speed remains unchanged, and imaging is left managing the same overwhelming volume under the same unrealistic time constraints.

Imagine a hospital where every department functions the way imaging is expected to:

• Pharmacy: Every single medication order is marked STAT, whether it’s aspirin or epinephrine. The pharmacy scrambles to process every order immediately, leaving critical medications delayed as they drown in a sea of urgent requests.
• The Lab: Every blood sample is expected to be analyzed immediately, regardless of whether it’s a routine metabolic panel or an emergent septic workup. Techs in the lab are forced to prioritize based on who escalates the loudest rather than clinical necessity.
• Surgery: Every surgical case is scheduled as an emergency, whether it’s a ruptured aortic aneurysm or an elective hernia repair. The operating room is in a constant state of chaos, with teams scrambling to accommodate every request at once, delaying truly life-threatening procedures while non-urgent cases consume critical resources.
• Food Services: Every patient meal request is treated as urgent, forcing the kitchen to mass-produce meals at lightning speed, leading to errors and inefficiencies while those with specific dietary accommodations are left waiting.
• Nursing: Every call light is treated as a life-threatening emergency, whether it’s a patient requesting a blanket or one in respiratory distress. Nurses rush from room to room without clear prioritization, potentially delaying life-saving interventions.

If every department worked this way, the system would collapse under its own weight of improper prioritization. And yet, this is precisely what has happened to imaging.

Our struggle with inappropriate STAT orders is a symptom of a much larger issue: the failure to distinguish true urgency from convenience-driven expectations. But while the problem is widespread, it is not without precedent or solution. Across the country, health systems have begun to respond with structure, transparency, and shared accountability. While imaging departments often bear the brunt of the problem, the most successful interventions recognize this is a hospital-wide challenge that demands a coordinated response.

One such strategy involves applying Lean and Six Sigma principles to streamline imaging workflows and prioritize orders based on clinical need. Booth et al. (2014) described how an imaging department in the UK successfully used Lean methodology to reduce STAT overuse by identifying process bottlenecks and implementing structured prioritization tiers. By involving frontline staff in the redesign of workflows, they increased adherence to urgency protocols and reduced turnaround times for truly emergent cases. This approach helped shift the departmental culture from reactive to proactive, using data and cross-functional engagement to recalibrate how urgency was defined and operationalized⁴.

Building on this type of structured approach, researchers at a large academic medical center in the United States documented success after launching an initiative to curb inappropriate STAT imaging. By introducing stricter prioritization criteria and auditing STAT request patterns, the institution reduced unnecessary urgent orders and improved imaging workflow efficiency⁷.

Another high-impact solution comes from health systems that utilize real-time order auditing and decision support interventions. Clinical governance models that regularly track and analyze the frequency and appropriateness of STAT orders by unit or provider group allow institutions to identify misuse trends and intervene early. Kruskal et al. (2012) outlined the effectiveness of this strategy, noting that when ordering patterns were tied to feedback and peer comparison, inappropriate STAT usage declined, and clinical teams began to recalibrate expectations around imaging timelines. Organizations that tied these insights to provider education sessions and ordering platform redesigns found even greater success, moving the burden from imaging back to the point of origin⁸.

Embedded imaging liaisons have also proven effective, particularly in large academic and integrated health systems. Institutions like Mayo Clinic and Geisinger have created roles that allow imaging leaders to partner directly with clinical departments, offering just-in-time coaching on when STAT is warranted and helping teams build internal escalation protocols.

While adding a dedicated full-time employee may seem costly, ACR Imaging 3.0 case studies consistently show that the financial investment in these roles is far outweighed by the broader organizational impact of reducing unnecessary imaging, improving turnaround times, offering shorter lengths of stay, and enhancing throughput — all of which translate to significant downstream savings. When providers are given ownership over prioritization, paired with education on the systemic impact of misuse, they become allies in reducing noise rather than contributors to it.

Finally, organizations where patient safety and quality teams have begun integrating STAT utilization metrics into broader hospital performance dashboards are seeing real progress. By tracking and publicly reporting overuse trends, institutions are driving accountability across the full continuum of care.

However, for these efforts to be truly effective, there must be deliberate collaboration between imaging-specific quality and safety leaders and the hospital’s central quality infrastructure. Too often, these hospital teams are predominantly nursing-led and may lack the nuanced understanding of imaging's operational complexity, leading to well-intentioned but misaligned solutions.

Embedding individuals with imaging operations expertise into these discussions ensures that improvement efforts are grounded in the realities of imaging workflows, resource constraints, and clinical appropriateness. When imaging is not just measured, but meaningfully included in quality strategy, systems can achieve better alignment, reduce technologist burnout, improve throughput, and sharpen focus on the patients who truly need timely imaging the most.

These solutions are not hypothetical. They are in motion today, implemented by organizations that recognized the cost of inaction and chose to respond with structure, communication, and shared responsibility. The question now is not whether solutions exist, but whether a healthcare system is willing to adopt them widely and urgently.

The Path Forward

Hospitals function within finite constraints. Without a structured triage system, decision-making can become chaotic, leading to inefficiencies, misallocation of resources, and potentially preventable deaths. The ethical framework of triage prioritizes care for those most likely to benefit from immediate treatment, following the principle of maximizing overall survival rather than treating patients based on the provider who makes the most noise.

However, this challenge is no longer just about prioritization, but it is about capacity. Imaging professionals are in increasingly short supply, with workforce shortages making it impossible to meet normal demands, let alone the expanding needs of growing health systems.

Unlike some service lines that can scale up or down with relative ease, imaging requires highly trained professionals who cannot be replaced overnight. The expectation that every imaging request must be fulfilled immediately is simply not sustainable under these workforce constraints.

If healthcare continues to prioritize immediacy over clinical necessity, imaging, and ultimately patient care, will continue to suffer. The solution is not for imaging to wage this battle alone, but for the system as a whole to realign with the principles of medical urgency.

Only through a multi-disciplinary effort can we restore meaning to STAT and ensure that true emergencies receive the prioritization they deserve. To initiate meaningful change, we must ask ourselves:

• Who will own the difficult conversations with clinical leaders and stakeholders to challenge the overuse of STAT orders?
• Are we designing imaging workflows that reflect clinical urgency or merely responding to noise?
• What structural changes are needed to redefine STAT as a tool for critical care, not convenience?
• Which measurable indicators can reveal patterns of overuse and who is accountable for acting on them?
• How are we empowering ordering providers to understand the downstream consequences of STAT misuse?
• What cultural shifts are necessary to reject immediacy for immediacy’s sake and protect the integrity of patient care?

We must collectively rethink how urgency is defined, particularly in inpatient imaging.

A Final Thought

Imaging is at a breaking point. For too long, we have been the silent workhorse of healthcare, absorbing inefficiencies, navigating imaging equipment far beyond its useful life, accommodating unrealistic expectations, and bearing the blame for systemic failures that extend far beyond our control.

Simply put, we are drowning. Not because we lack skill, dedication, or efficiency, but because the system itself has lost sight of what true urgency means.

Our departments are gridlocked by the unchecked ordering practices of others. The expectation of instant imaging, often without clinical justification, has turned our essential role in patient care into an unsustainable race against an ever-growing tide of STAT requests. We are called to account for barriers we did not create, forced to answer for system-wide inefficiencies we cannot fix alone.

This is not just a matter of workflow disruption; it is a matter of patient safety. The overuse of STAT imaging has diluted the very meaning of urgency, creating bottlenecks that place critically ill patients in direct competition with cases that, in any rational system, would be handled through standard protocols.

If imaging continues to shoulder this burden alone, we will break. We are already seeing the consequences: technologists and radiologists stretched beyond capacity, burnout at an all-time high, and the erosion of a field that is foundational to modern medicine.

We cannot be the only voices calling for change. We need our colleagues, providers, nurses, and hospital administrators to recognize that the current trajectory is unsustainable. We need hospital leadership to acknowledge that imaging is not a limitless resource that can be stretched indefinitely without consequence. We need systemic reform that redefines urgency based on clinical necessity, not convenience.

The time to intervene is now. The time to support imaging is now. If we fail to act, the entire healthcare system and the patients who depend on us will suffer.

We are drowning in STAT, and without collective action, the tide will overwhelm us all.

References

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3. Griffiths, W. H. (1875). Lessons on prescriptions and the art of prescribing. Philadelphia: Lindsay & Blakiston.
4. Booth, T. C., Boyd-Eliot, C., Burkill, G., McCoubrie, P., & Malhotra, A. (2014). Quality improvement in radiology: Lean lessons from the kitchen. Clinical Radiology, 69(11), 1113–1117. https://doi.org/10.1016/j.crad.2014.06.009Centers for Disease Control and Prevention. (2014). Mass casualty triage: Facts at a glance. U.S. Department of Health & Human Services. https://www.cdc.gov/
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7. Scalzetti, D. J., Ankenbrandt, W. J., Legare, M., & Shieh, J. (2019). Curbing inappropriate usage of STAT imaging at a large academic medical center. Journal of Patient Safety, 15(1), 27–31.
8. Kruskal, J. B., Eisenberg, R., Sosna, J., Boiselle, P. M., & Kruskal, J. D. (2012). Strategies for establishing a comprehensive quality and performance improvement program in a radiology department. Radiographics, 32(2), 623–639. https://doi.org/10.1148/rg.322115139