Stacy Dorothy O'Connor MD, Presenter: Nothing to Disclose

Aaron D. Sodickson MD, PhD, Abstract Co-Author: Nothing to Disclose

Ivan Ip MD, MPH, Abstract Co-Author: Nothing to Disclose

Ali Raja MD, MBA, Abstract Co-Author: Medical Advisor, Diagnotion, LLC

Luciano Monte Serrat Prevedello MD,MPH, Abstract Co-Author: Nothing to Disclose

Wendy Mar, Abstract Co-Author: Nothing to Disclose

Michael J. Healey MD, Abstract Co-Author: Nothing to Disclose

Louise Isabel Schneider MD, Abstract Co-Author: Nothing to Disclose

Ramin Khorasani MD, Abstract Co-Author: Stockholder, Medicalis Corp Royalties, Medicalis Corp Advisory Board, General Electric Company

Evaluate the impact of a multi-screen decision support alert on repeat use of CT.

This institutional review board-approved, pre-post study was conducted at a 776-bed academic medical center with computerized physician order entry and decision support systems. Previously, a single-screen alert notified orderers in real-time if the patient’s same body part had been imaged with the same modality within 90 days. Providers could ignore the alert and proceed, or drop the order. The intervention was a multi-screen repeat decision support alert. Orderers ignoring the single-screen alert received a second screen requiring selecting a clinical justification from a predetermined menu to complete the order, otherwise it was dropped. All 28,420 CT orders triggering a repeat alert in 2010, excluding those for malignancy restaging (n=11,862), were included. Primary outcome was proportion of dropped orders, evaluated with the Chi-square statistic. Multiple logistic regression assessed effect of care setting, orderer role, patient age and gender.

682/6,542 (10.4%) of CT orders triggering single-screen alerts were dropped; the multi-screen alert resulted in a 12.9% (1,290/10,016) drop rate (23% relative decrease; p<0.0001). Care setting and orderer role were significant predictors (p<0.0001). Intervention effect size was largest in the Emergency Department (68%), smallest for inpatients (16%), and 33% for authorized providers (orders not requiring counter-signature).

A multi-screen decision support alert requiring clinical justification to proceed with a repeat CT order prevented 1 in 8 CT orders, significantly enhancing the impact of a single-screen alert which prevented 1 in 10 repeat CT orders.  

Multi-screen decision support (DS) significantly reduces repeat CT orders; some proportion of dropped orders are likely unnecessary exams. Our study helps inform optimum DS design and implementation.

O'Connor, S, Sodickson, A, Ip, I, Raja, A, Prevedello, L, Mar, W, Healey, M, Schneider, L, Khorasani, R, Impact of a Multi-screen Decision Support Alert on Repeat Use of CT.  Radiological Society of North America 2013 Scientific Assembly and Annual Meeting, December 1 - December 6, 2013 ,Chicago IL. http://archive.rsna.org/2013/13014631.html