An Electronic Health Record Order Entry-Enabled Educational Intervention Is Not Effective in Reducing STAT Inpatient Radiology Orders

被引：1

作者：

Trinh, Tony W. ^{[1
]}

Ip, Ivan ^{[1
]}

Healey, Michael J. ^{[2
]}

Landman, Adam B. ^{[3
]}

Morris, Charles ^{[2
]}

Boland, Giles W. ^{[1
]}

Khorasani, Ramin ^{[1
]}

机构：

[1] Harvard Med Sch, Brigham & Womens Hosp, Dept Radiol, Ctr Evidence Based Imaging, Boston, MA 02115 USA

[2] Harvard Med Sch, Brigham & Womens Hosp, Dept Med, Boston, MA 02115 USA

[3] Harvard Med Sch, Brigham & Womens Hosp, Dept Emergency Med, Boston, MA 02115 USA

来源：

JOURNAL OF THE AMERICAN COLLEGE OF RADIOLOGY | 2019年 / 16卷 / 08期

关键词：

IT intervention; inpatient STAT orders; order entry intervention; STAT radiology orders;

D O I：

10.1016/j.jacr.2019.01.033

中图分类号：

R8 [特种医学]; R445 [影像诊断学];

学科分类号：

1002 ; 100207 ; 1009 ;

摘要：

Objective: Assess whether introducing order priorities with defined performance expectations in the electronic health record (EHR) reduces immediate inpatient radiology orders. Materials and Methods: This Institutional Review Board approved, retrospective study was performed at a 776-bed academic hospital conducting 164,000+ inpatient radiology examinations annually. Study period was January 2, 2017, to July 23, 2017; 14 weeks pre- and postimplementation of an education-only intervention including replacing urgent and as soon as possible priorities with imaging within next 6, 12, or 24 hours; imaging in the morning; and required for discharge priorities. STAT routine, timed, today order priorities remained unchanged. Institution-wide training immediately pre- and postimplementation was provided through two waves of e-mail and electronic tip sheets. Primary outcome measure was total STAT studies ordered of total radiology studies ordered per week (STAT rate). Secondary outcomes were non-STAT, non-routine (non-SR) order rate, and routine order rate. Paired t test and statistical process control (SPC) analysis were performed. Results: STAT rate pre- (22.5%, 7,150 STAT of 31,765 total; weeks 1-14) and postintervention (23.4%, 7,481 STAT of 32,034 total; weeks 16-29) remained unchanged (P = .37). SPC demonstrated no special cause variation. Postintervention non-SR rate increased 3-fold (2.7%, 859 non-SR of 31,765 total pre-intervention versus 8.2%, 2,615 non-SR of 32,034 total postintervention; 8.2%/2.7% = 3.0; P < .0001). There was an 8.8% relative reduction in routine rate postintervention (73.9%, 23,471 routine of 31,765 total pre intervention; 67.4%, 21,579 routine of 32,034 total postintervention; (73.9% - 67.4%)/73.9% x 100 = 8.8%; P < .0001). Conclusion: Implementing ordering priorities with defined performance expectations in the EHR reduced routine but did not reduce STAT inpatient radiology orders. More stringent interventions may be needed to reduce unnecessary STAT inpatient radiology ordering to improve use of limited imaging resources.

引用

页码：1018 / 1026

页数：9