Chad Klochko MS, MD, Presenter: Nothing to Disclose

Andrew Kent Moriarity MD, Abstract Co-Author: Nothing to Disclose

Matthew O'Brien MD, Abstract Co-Author: Nothing to Disclose

Safwan Halabi MD, Abstract Co-Author: Nothing to Disclose

To measure the rate of proxy delegation in the inpatient setting for advanced imaging requests and identify differences in proxy utilization and request appropriateness before and after implementation of clinical decision support between provider and proxy groups and by specialty.

An IRB approved retrospective review was performed of 68,976 requests for advanced imaging examinations over 34-months with a 17-month cross-over for clinical decision support (CDS) implementation. The rate of proxy entry and request appropriateness score generated by point of care CDS using the American College of Radiology Appropriateness Criteria was analyzed by specialty.

There were 22,564 and 46,405 inpatient requests for advanced imaging prior to and following implementation of CDS respectively originating from 43 distinct clinical specialties. Electronic order entry was delegated to a proxy in 86.4% and 85.8% of requests respectively. The largest contributors to overall advanced inpatient imaging volume were neurology (24%), internal medicine (14%), neurosurgery (10%), hospitalists (9%) and general surgery (6%). One-quarter (11 of 43) specialties had a 100% rate of proxy request entry delegation, 19 more had rates greater than 90% and only 6 had rates lower than 50%. Acute care surgery, cardiothoracic surgery, interventional radiology, orthopedic surgery, pediatrics, and thoracic surgery demonstrated a slight increase in the average request appropriateness when entered by the responsible physician compared to a proxy. No specialties demonstrated a significant decrease in request appropriateness when the request was entered by the physician compared to a proxy.

Proxy ordering is the most common method of submitting electronic requests for advanced imaging in our inpatient population with the majority of referring services utilizing proxies more than 75% of the time. A minority of specialties demonstrated a slight increase in overall request appropriateness when advanced imaging requests were entered by the responsible physician compared to a proxy provider. Clinical decision support did not significantly increase request appropriateness in either group.

Proxy entry of advanced inpatient imaging is common and the appropriateness of such requests is comparable to direct entry by the supervising physician, therefore this practice should be permitted.

Klochko, C, Moriarity, A, O'Brien, M, Halabi, S, Delegating Imaging Order Entry: How Common Is Proxy Ordering and Does It Influence Appropriateness of Advanced Inpatient Imaging Requests?.  Radiological Society of North America 2014 Scientific Assembly and Annual Meeting, - ,Chicago IL. http://archive.rsna.org/2014/14004569.html