Unscheduled Radiologic Examination Orders in the Electronic Health Record: A Novel Resource for Targeting Ambulatory Diagnostic Errors in Radiology |
| |
| Affiliation: | 1. Department of Radiology, Brigham and Women’s Hospital, Boston, Massachusetts;2. Harvard Medical School, Boston, Massachusetts;3. Department of Medicine, Brigham and Women’s Hospital, Boston, Massachusetts;4. Department of Radiology, Weill Cornell Medicine, New York, New York;5. Department of Emergency Medicine, Brigham and Women’s Hospital, Boston, Massachusetts;6. Department of Anesthesiology, Brigham and Women’s Hospital, Boston, Massachusetts;1. Department of Radiology, Rutgers – New Jersey Medical School, Newark, New Jersey;2. Department of Radiology, Department of Veterans Affairs National Teleradiology Program, Durham, North Carolina and Wake Forest University Baptist Medical Center, Winston-Salem, North Carolina;3. Department of Radiology, Baylor College of Medicine, Houston, Texas;4. Montefiore Medical Center, The University Hospital at Albert Einstein College of Medicine, Bronx, New York;5. Southern Illinois University School of Medicine, Springfield, Illinois;6. Department of Interventional Radiology, MD Anderson Cancer Center, Houston, Texas;7. Crozer Chester Medical Center, Upland, Pennsylvania;8. Department of Radiology, The Ohio State University College of Medicine, Columbus, Ohio;9. Thoracic Imaging Division, VCU Health Systems, Richmond, Virginia;10. Detroit Medical Center, Envision Physician Services, Detroit, Michigan;1. Department of Radiology, Boston University Medical Center, Boston, Massachusetts;2. Department of Radiology, New York University Langone Health, New York, New York;3. Department of Radiology, University of Washington Medical Center, Seattle, Washington;4. Department of Radiology, Vanderbilt University Medical Center, Nashville, Tennessee;1. Department of Radiology and Biomedical Imaging, University of California, San Francisco, California;2. Department of Radiology and Imaging Sciences, Emory University School of Medicine, Atlanta, Georgia;3. Department of Medicine, Health Policy Research Center, The Mongan Institute, Massachusetts General Hospital, Boston, Massachusetts;4. Department of Radiology, Brigham & Women’s Hospital, Harvard Medical School, Boston, Massachusetts;5. Department of Radiology, Duke Medical School, Durham, North Carolina;6. Departments of Radiology and Obstetrics and Gynecology, University of Michigan, Ann Arbor, Michigan;1. Department of Radiology and Imaging Sciences, Emory University, Atlanta, Georgia;2. Department of Radiology, Massachusetts General Hospital, Boston, Massachusetts;3. Department of Radiology and Imaging Sciences, University of Utah, Salt Lake City, Utah |
| |
| Abstract: | PurposeThe aim of this study was to assess the prevalence of unscheduled radiologic examination orders in an electronic health record, and the proportion of unscheduled orders that are clinically necessary, by modality.MethodsThis retrospective study was conducted from January to October 2016 at an academic institution. All unscheduled radiologic examination orders were retrieved for seven modalities (CT, MR, ultrasound, obstetric ultrasound, bone densitometry, mammography, and fluoroscopy). After excluding duplicates, 100 randomly selected orders from each modality were assigned to two physician reviewers who classified their clinical necessity, with 10% overlap. Interannotator agreement was assessed using κ statistics, the percentage of clinically necessary unscheduled orders was compared, and χ2 analysis was used to assess differences by modality.ResultsA total 494,503 radiologic examination orders were placed during the study period. After exclusions, 33,546 unscheduled orders were identified, 7% of all radiologic examination orders. Among 700 reviewed unscheduled orders, agreement was substantial (κ = 0.63). Eighty-seven percent of bone densitometric examinations and sixty-five percent of mammographic studies were considered clinically necessary, primarily for follow-up management. The majority of orders in each modality were clinically necessary, except for CT, obstetric ultrasound, and fluoroscopy (P < .0001).ConclusionsLarge numbers of radiologic examination orders remain unscheduled in the electronic health record. A substantial portion are clinically necessary, representing potential delays in executing documented provider care plans. Clinically unnecessary unscheduled orders may inadvertently be scheduled and performed. Identifying and performing clinically necessary unscheduled radiologic examination orders may help reduce diagnostic errors related to diagnosis and treatment delays and enhance patient safety, while eliminating clinically unnecessary unscheduled orders will help avoid unneeded testing. |
| |
| Keywords: | Medical order entry systems diagnostic imaging diagnostic errors delayed diagnosis patient safety |
| 本文献已被 ScienceDirect 等数据库收录！ |
|
