Many Clinically Necessary Radiology Exams Remain Unscheduled After 30 Days

An AHRQ-funded analysis found that 7 percent of nearly 495,000 radiology orders remained unscheduled 30 days after orders were made. Two physician reviewers who then assessed a subset of 700 randomly selected unscheduled orders found 87 percent of bone density exams and 67 percent of mammograms were clinically necessary. They also found that clinically unnecessary orders, such as duplicate orders for the same exam, may inadvertently be scheduled and performed, which could negatively impact the quality, safety and experience of care for patients. Access the abstract of the study, published in the Journal of the American College of Radiology.

Unscheduled Radiologic Examination Orders in the Electronic Health Record: A Novel Resource for Targeting Ambulatory Diagnostic Errors in Radiology

Ronilda Lacson 1, Michael J Healey 2, Laila R Cochon 3, Romeo Laroya 3, Keith D Hentel 4, Adam B Landman 5, Sunil Eappen 6, Giles W Boland 7, Ramin Khorasani 7

Affiliations

PMID: 31954707
DOI: 10.1016/j.jacr.2019.12.021

Abstract

Purpose: The aim of this study was to assess the prevalence of unscheduled radiologic examination orders in an electronic health record, and the proportion of unscheduled orders that are clinically necessary, by modality.

Methods: This retrospective study was conducted from January to October 2016 at an academic institution. All unscheduled radiologic examination orders were retrieved for seven modalities (CT, MR, ultrasound, obstetric ultrasound, bone densitometry, mammography, and fluoroscopy). After excluding duplicates, 100 randomly selected orders from each modality were assigned to two physician reviewers who classified their clinical necessity, with 10% overlap. Interannotator agreement was assessed using κ statistics, the percentage of clinically necessary unscheduled orders was compared, and χ2 analysis was used to assess differences by modality.

Results: A total 494,503 radiologic examination orders were placed during the study period. After exclusions, 33,546 unscheduled orders were identified, 7% of all radiologic examination orders. Among 700 reviewed unscheduled orders, agreement was substantial (κ = 0.63). Eighty-seven percent of bone densitometric examinations and 65% of mammographic studies were considered clinically necessary, primarily for follow-up management. The majority of orders in each modality were clinically necessary, except for CT, obstetric ultrasound, and fluoroscopy (P < .0001).

Conclusions: Large numbers of radiologic examination orders remain unscheduled in the electronic health record. A substantial portion are clinically necessary, representing potential delays in executing documented provider care plans. Clinically unnecessary unscheduled orders may inadvertently be scheduled and performed. Identifying and performing clinically necessary unscheduled radiologic examination orders may help reduce diagnostic errors related to diagnosis and treatment delays and enhance patient safety, while eliminating clinically unnecessary unscheduled orders will help avoid unneeded testing.

Keywords: Medical order entry systems; delayed diagnosis; diagnostic errors; diagnostic imaging; patient safety.