Closing the Loop on Unscheduled Diagnostic Imaging Orders: A Systems-Based Approach

Area of Science:

• Radiology
• Health Informatics
• Patient Safety

Background:

• Unscheduled orders for outpatient diagnostic imaging can lead to delays and potential patient safety issues.
• Managing these orders within an electronic health record (EHR) system presents challenges.

Purpose of the Study:

• To describe the System for Coordinating Orders for Radiology Exams (SCORE) for managing unscheduled outpatient diagnostic imaging orders.
• To assess SCORE's impact on the rate of unscheduled orders.
• To evaluate the clinical necessity of canceled, expired, scheduled, and performed orders.

Main Methods:

• Retrospective study at a large academic institution (October 2017 - July 2019).
• Description of SCORE's design, implementation (people, processes, tools), and EHR integration.
• Comparison of unscheduled order rates before and after SCORE implementation using chi-squared analysis.
• Multivariate analysis of factors related to order resolution for 447 randomly selected orders.
• Manual assessment of clinical necessity by two physicians.

Main Results:

• Unscheduled orders decreased by 49%, from 8.6% before SCORE to 4.4% after SCORE (P < .00001).
• Among resolved orders, 57% were canceled, 21% expired, 1% scheduled, and 11% performed.
• A significant portion of canceled (32%) and expired (27.7%) orders remained clinically necessary, attributed to scheduling and patient factors.

Conclusions:

• SCORE implementation led to a significant reduction in unscheduled diagnostic imaging orders.
• This patient safety initiative has the potential to mitigate errors associated with diagnostic delays.