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Efficacy, Education, Administration, Informatics

E2764. The Right Side of History: Obtaining Appropriate History for Ordered Studies to Improve Patient Care

Gnerre J,  Dietsche E,  Qadwai S,  Lim M,  Gilet A. Westchester Medical Center, Valhalla, NY

Address correspondence to J. Gnerre (jeffrey.gnerre@wmchealth.org)

Objective: Failure of ordering physicians to provide the radiologist with adequate clinical information can result in significant patient harm. Radiologists may inadvertently recommend follow-up studies that are not necessary, which results in unnecessary radiation exposure, increased healthcare cost, and increased patient anxiety. We developed an interdisciplinary quality initiative with the goal of educating ordering services on what is considered adequate and appropriate history when ordering radiologic studies. We hope this initiative not only improves quality of patient care, but also facilitates communication and builds stronger relationships among the radiology department and other ordering services.

Materials and Methods: We conducted a retrospective analysis of all unenhanced and contrast-enhanced CT studies of the abdomen and pelvis as well as unenhanced CT studies of the head ordered by all inpatient services (e.g., internal medicine, surgery, pediatrics) and the emergency medicine department over a 1-month period, defined as our preimplementation group. For each examination, we subjectively graded each provided clinical history with qualitative labels based on a three-point scale of 1 = sufficient, 2 = limited, and 3 = insufficient. Following our qualitative analysis, implementation of an educational series was provided by the department of radiology to the inpatient departments. The department of emergency medicine served as our control group. In our educational lecture, we detailed helpful ways in which ordering physicians may provide critical information in their clinical histories that would allow radiologists to better interpret and convey appropriate results. Clinical examples of how inappropriate or inadequate clinical history can cause harm to the patient were also shown. At the conclusion lecture, literature was distributed to supplement our lecture. Following our interdisciplinary lecture series, we conducted a similar retrospective analysis of all unenhanced and contrast-enhanced CT studies of the abdomen and pelvis as well as unenhanced studies of the head ordered by all services over a 1-month period, defined as our postimplementation group.

Results: During the preimplementation period, a total of 10% (32/334) of studies were ordered with “Sufficient history” provided to the radiologist: 9% (14/150) from the emergency department and 10% (18/184) from inpatient services. During the postimplementation period, a total of 14% (114/811) of studies were ordered with sufficient history provided to the radiologist: 6% (19/311) from the emergency department and 19% (95/500) from inpatient services.

Conclusion: There was a clear improvement in the quality of provided histories for CT studies ordered from inpatient departments as opposed to the emergency department following our educational series. Additionally, we now plan to include our educational series in orientation proceedings for incoming residents at our institution. It is our hope that by encouraging strong communication between our radiology department and other ordering services we will continue to improve patient care.