Dustin Boatman MD, Abstract Co-Author: Nothing to Disclose

Ryan Patrick McWey, Presenter: Nothing to Disclose

Michael Hanshew MS, Abstract Co-Author: Nothing to Disclose

Cree Michael Gaskin MD, Abstract Co-Author: Research Consultant, Johnson & Johnson Author with royalties, Oxford University Press Author with royalties, Thieme Medical Publishers, Inc

A simple, defined, and hierarchical numeric exam order priority system was associated with desirable impacts upon exam perform time, including appropriate stratification by priority as well as improved uniformity amongst high priority orders, compared to results with a conventional alphabetic order priority system.

Conventional radiology order priority systems often include alphabetic levels of priority, e.g., STAT, routine, and ASAP. Such choices offer potentially competing or ambiguous priorities. Informal polling of MD’s and chief techs at our site revealed lack of consensus on prioritization using the alphabetic system. Our institution switched to a strictly numeric system with defined hierarchy to better leverage the ordering provider's level of concern for inpatient and ED exams and convey it more clearly to the technologists.

This QI project was not human subject research. We retrospectively reviewed the order-to-perform time (OTPT) parsed by order priority for all ED and inpatient radiology exams (n=136,652), excluding fluoroscopy, for the same six months (Mar-Aug) one year prior to and immediately after implementation of the numeric system. A hard stop requirement to choose a priority was also added.

Prior to implementation of the numeric system, our 9 most commonly used alphabetic order priorities and their average (OTPT) in hours(std dev) for all modalities combined were ASAP 4.4(7.6), PRIOR1 0.9(2.15), PRIOR2 0.5(0.76), PRIOR3 0.9(1.4), PRIOR4 1.9(2.5), PRIORITY 0.4(2.59), ROUTINE 6.7(11.9), STAT 1.1(1.6) and BLANK (i.e, no selection) 6.5(12.3) (Fig.—left side). The hierarchical options of PRIOR1-4 were extra options for radiographs only. After implementation of the numeric order priority system of 1-4 with defined descriptions, OTPTs for all modalities by priority were 1.4(4.1), 1.7(3.4), 5.8(17.1), and 8(33.7) hrs (Fig.—right side). Similar improvements were reflected by each modality. There was desirable stratification of OTPTs after implementation of the numeric system while there was less dependable stratification with the alphabetic system. Smaller STD DEV values for high priority studies indicated greater uniformity in perform times.

Boatman, D, McWey, R, Hanshew, M, Gaskin, C, Replacement of a Conventional Alphabetic ORDER (PERFORM) PRIORITY System with a Stratified Numeric System: Implementation and Impact on EXAM PERFORM TIME at a Large Academic Medical Center.  Radiological Society of North America 2013 Scientific Assembly and Annual Meeting, December 1 - December 6, 2013 ,Chicago IL. http://archive.rsna.org/2013/13015297.html