Errors in placing imaging orders occur more frequently than one might think. But one institution has devised a quality intervention that has reduced the rate by 83%, researchers detailed recently in JACR [1].
Brigham and Women’s experts estimated that, in vascular imaging, such improper ordering occurred in about 16% of cases (50/306). This is an under-examined phenomenon, they added, with common reasons including selecting the wrong modality, technique, anatomy or contrast.
At the single, large academic center involved in the study, CT of the chest (with or without contrast) comprised the majority of erroneous imaging orders (44%). “Pre-op” was the most common reason for these exams (32%), with referrers in cardiac surgery (32%) and cardiology (22%) responsible for the most inaccurate orders.
The institution has since implemented a multistage improvement project that’s making a dent in the problem.
“Combining tailored order options in the [electronic health record] with education and feedback on practice habits can improve the accuracy of imaging orders, thereby mitigating the overall order error rates,” Ariadne K. DeSimone, MD, a cardiothoracic radiologist with Brigham and Women’s, and co-authors wrote Jan. 2.
For the study, researchers analyzed all 844 vascular imaging orders placed prior to the intervention in segments of July and September 2021. The institution later implemented customized ordering options within the EHR for pre-op cardiac surgery patients to help referrers select the right option. A second intervention involved educating and providing feedback to orderers about their work. A radiology trainee also identified incorrect orders, pinpointing if the reasoning did not match up with the request. They rectified this by confirming details with the ordering provider.
After the intervention, the error rate fell by 83%, from 16% to 3% (10/353). DeSimone et al. noted that the improvement appeared “durable,” with the error rate remaining at 3% (6/185) for the four months that followed the practice change. All four of the most common ordering departments were able to reduce their error rates following the intervention, the authors added. Prior to it, physicians (42%) and administrative assistants (38%) accounted for most incorrect orders. During the study, chest CT (with or without contrast) was most often changed to CT angio chest or CT chest (vascular) without contrast. Incorrect orders for CT angio chest, meanwhile, were typically switched to CT pulmonary angiogram.
“Future studies will be needed to reduce incorrect order types in other radiology subspecialties, or to use other data sources (such as denied insurance claims for imaging examinations) to quantify the burden of incorrect orders,” DeSimone et al. wrote in the “take home points” section of the study. “In areas of diagnostic overlap (cardiovascular and thoracic imaging), discussions between and consensus among subspeciality divisions and ordering departments may improve workflow and reduce errors,” they added.
Read more about the results, including potential study limitations, at the link below.
Marty Stempniak has covered healthcare since 2012, with his byline appearing in the American Hospital Association's member magazine, Modern Healthcare and McKnight's. Prior to that, he wrote about village government and local business for his hometown newspaper in Oak Park, Illinois. He won a Peter Lisagor and Gold EXCEL awards in 2017 for his coverage of the opioid epidemic.