Impact of Radiologist-Driven Change-Order Requests on Outpatient CT and MRI Examinations
Autor: | Joseph J. Cavallo, Howard P. Forman, Amir Imanzadeh, Lawrence H. Staib, Jennifer Arango, Irena Tocino, Sarvenaz Pourjabbar, Jay Pahade |
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Rok vydání: | 2020 |
Předmět: |
Intravenous contrast
medicine.medical_specialty Demographics business.industry Patient-centered care Magnetic Resonance Imaging Tertiary care Appropriateness criteria 030218 nuclear medicine & medical imaging Radiation exposure 03 medical and health sciences 0302 clinical medicine 030220 oncology & carcinogenesis Statistical significance Outpatients Radiologists medicine Humans Radiology Nuclear Medicine and imaging sense organs Radiology Tomography X-Ray Computed skin and connective tissue diseases business Physical Examination |
Zdroj: | Journal of the American College of Radiology. 17:1014-1024 |
ISSN: | 1546-1440 |
Popis: | PURPOSE To assess impact of electronic medical record-embedded radiologist-driven change-order request on outpatient CT and MRI examinations. METHODS Outpatient CT and MRI requests where an order change was requested by the protocoling radiologist in our tertiary care center, from April 11, 2017, to January 3, 2018, were analyzed. Percentage and categorization of requested order change, provider acceptance of requested change, patient and provider demographics, estimated radiation exposure reduction, and cost were analyzed. P < .05 was used for statistical significance. RESULTS In 79,310 outpatient studies in which radiologists determined protocol, change-order requests were higher for MRI (5.2%, 1,283 of 24,553) compared with CT (2.9%, 1,585 of 54,757; P < .001). Provider approval of requested change was equivalent for CT (82%, 1,299 of 1,585) and MRI (82%, 1,052 of 1,283). Change requests driven by improper contrast media utilization were most common and different between CT (76%, 992 of 1,299) and MRI (65%, 688 of 1,052; P < .001). Changing without and with intravenous contrast orders to with contrast only was most common for CT (39%, 505 of 1,299) and with and without intravenous contrast to without contrast only was most common for MRI (26%, 274 of 1,052; P < .001). Of approved changes in CT, 51% (661 of 1,299) resulted in lower radiation exposure. Approved changes frequently resulted in less costly examinations (CT 67% [799 of 1,198], MRI 48% [411 of 863]). CONCLUSION Outpatient CT and MRI orders are deemed incorrect in 2.9% to 5% of cases. Radiologist-driven change-order request for CT and MRI are well accepted by ordering providers and decrease radiation exposure associated with imaging. |
Databáze: | OpenAIRE |
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