Improvement of radiology requisition

MRI spine request form enhancement and auto protocoling using a secure institutional large language model

BACKGROUND CONTEXT

Secure institutional large language models (LLM) could reduce the burden of noninterpretative tasks for radiologists.

PURPOSE

Assess the utility of a secure institutional LLM for MRI spine request form enhancement and auto-protocoling.

STUDY DESIGN/SETTING

Retrospective study conducted from December 2023 to February 2024, including patients with clinical entries accessible on the electronic medical record (EMR).

PATIENT SAMPLE

Overall, 250 spine MRI request forms were analyzed from 218 patients (mean age = 55.9 years ± 18.9 [SD]; 108 women) across the cervical (n=56/250, 22.4%), thoracic (n=13/250, 5.2%), lumbar (n=166/250, 66.4%), and whole (n=15/250, 6.0%) spine. Of these, 60/250 (24.0%) required contrast and 41/250 (16.4%) had prior spine surgery/instrumentation.

OUTCOME MEASURES

Primary-Adequacy of clinical information on clinician and LLM-augmented request forms were rated using a four-point scale. Secondary-Correct MRI protocol suggestion by LLM and first-year board-certified radiologists (Rad4 and Rad5) compared to a consensus reference standard.

METHODS

A secured institutional LLM (Claude 2.0) used a majority decision prompt (out of six runs) to enhance clinical information on clinician request forms using the EMR, and suggest the appropriate MRI protocol. The adequacy of clinical information on the clinician and LLM-augmented request forms was rated by three musculoskeletal radiologists independently (Rad1:10-years-experience; Rad2:12-years-experience; Rad3:10-years-experience). The same radiologists provided a consensus reference standard for the correct protocol, which was compared to the protocol suggested by the LLM and two first-year board-certified radiologists (Rad4 and Rad5). Overall agreement (Fleiss kappas for inter-rater agreement or % agreement with the reference standard and respective 95%CIs) were provided where appropriate.

RESULTS

LLM-augmented forms were rated by Rads 1-3 as having adequate clinical information in 93.6-96.0% of cases compared to 46.8-58.8% of the clinician request forms (p<0.01). Substantial interobserver agreement was observed with kappas of 0.71 (95% CI: 0.67-0.76) for original forms and 0.66 (95% CI: 0.61-0.72) for LLM-enhanced requests. Rads 1-3 showed almost perfect agreement on protocol decisions, with kappas of 0.99 (95% CI: 0.94-1.0) for spine region selection, 0.93 (95% CI: 0.86-1.0) for contrast necessity, and 0.93 (95% CI: 0.86-0.99) for recognition of prior spine surgery. Compared to the consensus reference standard, the LLM suggested the correct protocol in 78.4% (196/250, p<0.01) of cases, albeit inferior to Rad4 (90.0%, p<0.01) and Rad5 (89.2%, p<0.01). The secure LLM did best in identifying spinal instrumentation in 39/41 (95.1%) cases, improved compared to Rad4 (61.0%) and Rad5 (41.5%) (both p<0.01). The secure LLM had high consistency with 227/250 cases (90.8%) having 100% (6/6 runs) agreement.

CONCLUSIONS

Enhancing spine MRI request forms with a secure institutional LLM improved the adequacy of clinical information. The LLM also accurately suggested the correct protocol in 78.4% of cases which could optimize the MRI workflow.

Assessment of Reason for Exam Imaging Reporting and Data System (RI-RADS) in inpatient diagnostic imaging referrals

OBJECTIVES

To test the Reason for Exam Imaging Reporting and Data System (RI-RADS) in assessing the quality of radiology requests in an Italian cohort of inpatients; to evaluate the interobserver reliability of RI-RADS.

METHODS

A single-center quality care study was designed to retrospectively identify consecutive radiology request forms for computed tomography, magnetic resonance imaging, and conventional radiography examinations. One radiologist scored the requests using the RI-RADS. The association between RI-RADS and clinical request variables (urgent request, on-call requests, indication for imaging, requesting specialty, imaging modality, and body region) was evaluated. We calculated interobserver agreement between four readers in a subset of 450 requests.

RESULTS

We included 762 imaging requests. RI-RADS grades A (adequate request), B (barely adequate request), C (considerably limited request), D (deficient request), and X were assigned to 8 (1%), 49 (7%), 237 (31%), 404 (53%), and 64 (8%) of cases, respectively. In the multivariate analysis, the indication for imaging, body region, and requesting specialty significantly influenced the RI-RADS. Indications for imaging with a high risk of poor RI-RADS grade were routine preoperative imaging and device check requests. The upper extremity was the body region with the highest risk of poor RI-RADS grade. Requesting specialties with a high risk of poor RI-RADS grade were cardiovascular surgery, intensive care medicine, and orthopedics. The analysis of the interobserver agreement revealed substantial agreement for the RI-RADS grade.

CONCLUSION

The majority of radiology exam requests were inadequate according to RI-RADS, especially those for routine imaging. RI-RADS demonstrated substantial reliability, suggesting that it can be satisfactorily employed in clinical settings.

CRITICAL RELEVANT STATEMENT

The implementation of RI-RADS can provide a framework for standardizing radiology requests, thereby enabling quality assurance and promoting a culture of quality improvement.

KEY POINTS

RI-RADS aims to grade the completeness of radiology requests. Over half of the imaging requests were RI-RADS D grade; RI-RADS demonstrated substantial reliability. Most radiology requests were inadequate and RI-RADS could classify them in clinical practice.

Evaluating the Accuracy and Impact of the ESR-iGuide Decision Support Tool in Optimizing CT Imaging Referral Appropriateness

Radiology referral quality impacts patient care, yet factors influencing quality are poorly understood. This study assessed the quality of computed tomography (CT) referrals, identified associated characteristics, and evaluated the ESR-iGuide clinical decision support tool's ability to optimize referrals. A retrospective review analyzed 300 consecutive CT referrals from an acute care hospital. Referral quality was evaluated on a 5-point scale by three expert reviewers (inter-rater reliability κ = 0.763-0.97). The ESR-iGuide tool provided appropriateness scores and estimated radiation exposure levels for the actual referred exams and recommended exams. Scores were compared between actual and recommended exams. Associations between ESR-iGuide scores and referral characteristics, including the specialty of the ordering physician (surgical vs. non-surgical), were explored. Of the referrals, 67.1% were rated as appropriate. The most common exams were head and abdomen/pelvis CTs. The ESR-iGuide deemed 70% of the actual referrals "usually appropriate" and found that the recommended exams had lower estimated radiation exposure compared to the actual exams. Logistic regression analysis showed that non-surgical physicians were more likely to order inappropriate exams compared to surgical physicians. Over one-third of the referrals showed suboptimal quality in the unstructured system. The ESR-iGuide clinical decision support tool identified opportunities to optimize appropriateness and reduce radiation exposure. Implementation of such a tool warrants consideration to improve communication and maximize patient care quality.

Towards an improved dementia care experience in clinical radiography practice: A state-of-the-art review

INTRODUCTION

The increasing global incidence rate of dementia and associated co/multimorbidity has consequently led to a rise in the number of people with dementia (PwD) requiring clinical radiography care services. This review aims to explore and integrate findings from diverse settings with a focus on the experiences of PwD and stakeholders, towards the development of a holistic approach for dementia care and management within the context of radiography services.

METHOD

An electronic search was performed across the following databases: PUBMED, CINAHL, Medline, SCOPUS, and ScienceDirect for articles published from January 2009 and June 2023. Articles were included if they fulfilled a predefined criteria mainly focused on experiences of PwD and/or other stakeholders when using the radiography services. Data obtained from the included studies were analysed using a result-based convergent synthesis.

RESULT

Eleven studies from diverse settings met the inclusion criteria. A mix of both positive and negative experiences of PwD and stakeholders were reported following visits to radiology and radiotherapy departments were highlighted across settings. The findings were themed around the need for: person-centred care, effective communication, attitudinal changes of staff, specialised and improved clinical environment and inclusion of caregivers for the care of PwD.

DISCUSSION

This study emphasise the critical importance of adopting holistic approaches to caring for PwD. This involves adopting a person-centred approach, actively involving caregivers, effective communication, and adequate training for radiographers to provide quality services, all in dementia-friendly environments.

CONCLUSION

The experiences of various stakeholders highlight the need for a more holistic approach and strategy for the care and management of PwD within the context of the radiography services. This calls for an urgent need for a comprehensive strategy that includes awareness creation of staff to enhance the quality of care and the overall experience for PwD using the radiography services.

Adoption by clinicians of electronic order communications in NHS secondary care: a descriptive account

BACKGROUND

Due to the rapid advancement in information technology, changes to communication modalities are increasingly implemented in healthcare. One such modality is Computerised Provider Order Entry (CPOE) systems which replace paper, verbal or telephone orders with electronic booking of requests. We aimed to understand the uptake, and user acceptability, of CPOE in a large National Health Service hospital system.

METHODS

This retrospective single-centre study investigates the longitudinal uptake of communications through the Prescribing, Information and Communication System (PICS). The development and configuration of PICS are led by the doctors, nurses and allied health professionals that use it and requests for CPOE driven by clinical need have been described.Records of every request (imaging, specialty review, procedure, laboratory) made through PICS were collected between October 2008 and July 2019 and resulting counts were presented. An estimate of the proportion of completed requests made through the system has been provided for three example requests. User surveys were completed.

RESULTS

In the first 6 months of implementation, a total of 832 new request types (imaging types and specialty referrals) were added to the system. Subsequently, an average of 6.6 new request types were added monthly. In total, 8 035 132 orders were requested through PICS. In three example request types (imaging, endoscopy and full blood count), increases in the proportion of requests being made via PICS were seen. User feedback at 6 months reported improved communications using the electronic system.

CONCLUSION

CPOE was popular, rapidly adopted and diversified across specialties encompassing wide-ranging requests.

Classification of Musculoskeletal Radiograph Requisition Appropriateness Using Machine Learning

Objective: Poor quality imaging requisitions lower report quality and impede good patient care. Manual control of such requisitions is time consuming and can be a source of friction with referring physicians. The purpose of this study was to determine if poor quality requisitions could be identified automatically using machine learning and natural language processing techniques in order to allow for more efficient workflow. Methods: Exam indications from 50 000 musculoskeletal radiograph requisitions were manually classified, reviewed and deemed 'appropriate' or 'inappropriate' by two staff radiologists based on ACR appropriateness criteria. The requisitions were divided into training and test groups (80/20 split). The training set was pre-processed, converted to a bag-of-words model and used to train a Multinomial Naïve Bayes classifier which was then applied to the test set. Results: Out of 50 000 requisitions, 12 253 (24.5%) were deemed to contain an inappropriate indication. A Naive Bayes model correctly classified requisitions with an accuracy of 98%. In the test set, 107 of 7561 (1.4%) appropriate requisitions were incorrectly flagged and 92 of 2439 (3.8%) inappropriate requisitions were not flagged. Conclusions: Accurate automated identification of inappropriate indications on musculoskeletal requisitions is feasible using machine learning and natural language processing.

Reason for Exam Imaging Reporting and Data System: Consensus Reached on Quality Assessment of Radiology Requisitions

OBJECTIVE

The aim of this study was to reach consensus on quality assessment of clinical information in imaging requisitions using Reason for exam Imaging Reporting and Data System (RI-RADS).

METHODS

A Delphi study was conducted in September 2018 with a panel of 87 radiologists with diverse levels of experience from various settings (community hospitals, private hospitals, university hospitals, and clinics), of which 74.7% completed the survey. The agreement was assessed in the following subjects: (a) presumed effect of standardization, (b) the standardized system for information, (c) the scoring system for evaluation of requisitions, and (d) the implementation of RI-RADS. The consensus threshold was set at 51% responding (strongly) agree. The rate of lawsuits preventable with clinical information was also assessed.

RESULTS

Consensus was reached on all objectives of the study with a high level of agreement. Radiologists agreed on the need for standardization of imaging requisitions and attributed it to increased speed and accuracy of interpretations. Three categories of information were determined as key indicators of quality: impression, clinical findings, and clinical question. The scoring system is intended to grade requisitions based on the presence of these categories. Radiologists also agreed that RI-RADS will encourage physicians to improve requisitions. Among radiologists who responded to the survey, 12.6% had experienced at least one lawsuit potentially preventable with sufficient information in requisitions.

CONCLUSIONS

Reason for exam Imaging Reporting and Data System can be used as a standard for quality assessment of requisitions. Its use may improve the quality of patient care and reduce lawsuits against radiologists.

Requests for radiologic imaging: Prevalence and determinants of inadequate quality according to RI-RADS

PURPOSE

To determine the prevalence and determinants of radiologic imaging requests that are of inadequate quality according to the Reason for exam Imaging Reporting and Data System (RI-RADS).

METHODS

This study included a random sample of 673 radiologic examinations performed at a tertiary care center. The quality of each imaging request was graded according to RI-RADS. Ordinal regression analysis was performed to determine the association of RI-RADS grade with patient age, gender, and hospital status, indication for imaging, requesting specialty, imaging modality, body region, time of examination, and relationship with previous imaging within the past one year.

RESULTS

RI-RADS grades A (adequate request), B (barely adequate request), C (considerably limited request), and D (deficient request) were assigned to 159 (23.6 %), 166 (24.7 %), 214 (31.8 %), and 134 (19.9 %) of cases, respectively. Indication for imaging, requesting specialty, and body region were independently significantly associated with RI-RADS grades. Specifically, routine preoperative imaging (odds ratio [OR]: 3.422, P = 0.030) and transplantation imaging requests (OR: 8.710, P = 0.000) had a higher risk of poorer RI-RADS grades, whereas infection/inflammation as indication for imaging (OR: 0.411, P = 0.002), pediatrics as requesting specialty (OR: 0.400, P = 0.007), and head (OR: 0.384, P = 0.017), spine (OR: 0.346, P = 0.016), and upper extremity (OR: 0.208, P = 0.000) as body regions had a lower risk of poorer RI-RADS grades.

CONCLUSION

The quality of radiologic imaging requests is inadequate in >75 % of cases, and is affected by several factors. The data from this study can be used as a baseline and benchmark for further investigation and improvement.

Reason for exam Imaging Reporting and Data System (RI-RADS): A grading system to standardize radiology requisitions

Radiologists often encounter imaging requisitions that lack important information needed for accurate diagnostic studies. Reason for exam Imaging Reporting and Data System (RI-RADS) is proposed as a grading system for evaluation of the quality of clinically pertinent information provided in imaging requisitions. Three categories of information are suggested as key indicators of quality: impression, clinical findings, and the diagnostic question. This scheme is intended to improve the quality of imaging requisitions and overall patient care.

How to achieve patient-centered testing: role of the protocol nurse

INTRODUCTION

Patient-centered cardiac testing is predicated on choosing the right test for the right patient. We studied the effects of changing from script-driven scheduling to nurse-driven protocoling of stress tests.

METHODS AND RESULTS

A protocol nurse reviewed records before scheduling and communicated with patients and ordering providers if needed. We found that instituting nurse protocolling of all non-imaging (ETT) and nuclear (MPI) stress tests (N = 3071) resulted in protocol changes in 37% of our patients, and reduced the proportion of tests that could not be performed as scheduled by 56% and cancelations by 71% (P < 0.001 for each). These changes were sustained over two successive 6-month periods following a baseline observation period of 6 months. For MPI, the most frequent nurse interventions were re-protocoling as stress-first MPI (12% of tests), changing test location for clinical reasons (13%), changing stress modality (7%), and care coordination (5%).

CONCLUSIONS

Changing from script-driven scheduling to protocol nursing contributed measurably to patient-centered testing.

Bias in Radiology: The How and Why of Misses and Misinterpretations

Medical errors are a leading cause of morbidity and mortality in the medical field and are substantial contributors to medical costs. Radiologists play an integral role in the diagnosis and care of patients and, given that those in this field interpret millions of examinations annually, may therefore contribute to diagnostic errors. Errors can be categorized as a "miss" when a primary or critical finding is not observed or as a "misinterpretation" when errors in interpretation lead to an incorrect diagnosis. In this article, the authors describe the cognitive causes of such errors in diagnostic medicine, specifically in radiology. Recognizing the cognitive processes that radiologists use while interpreting images should improve one's awareness of the inherent biases that can impact decision making. The authors review the common biases that impact clinical decisions, as well as strategies to counteract or minimize the potential for misdiagnosis. System-level processes that can be implemented to minimize cognitive errors are reviewed, as well as ways to implement personal changes to minimize cognitive errors in daily practice. ©RSNA, 2017.

Auditing The Completeness and Legibility of Computerized Radiological Request Forms

Certain Saudi healthcare organizations transfer outpatients to medical imaging departments for radiological examinations in a manual process that relies on the use of paper-based forms. With the increased implementation of electronic medical records in Saudi Hospitals, little is known about the completeness and legibility of information captured in  electronic-based medical imaging forms. The purpose of this study is to audit the completeness and legibility of medical imaging paper-based forms in comparison with electronic-based medical imaging forms. As a secondary objective, we also examined the number of errors found on the forms.An observational retrospective cross-sectional study was utilized to audit the completeness and legibility of both paper and electronic forms collected between March 1 and May 15, 2015. The study measured the association among categorical variables using Chi-Square analysis. The results of this investigation show a significant association between form completion and type of record (i.e., paper vs. electronic) where electronic-based systems were found to be more complete than paper-based records. Electrnoic based records were also found to improve form legibility, promote user adherence to complete the forms and minimize entry errors. In conclusion, electronic-based medical imaging forms are more complete and legible than paper based forms. Future studies should evaluate other hospitals and compare both legibility and completeness of electronic-based medical imaging forms and conduct usability evaluation studies with users to explore the impacts of system design on both completeness and legibility of electronic forms, in general, but more specifically, electronic-based medical imaging forms.

Managing Incidentalomas Safely: Do Computed Tomography Requisitions Tell Us What We Need to Know?

PURPOSE

Technological advancements and the ever-increasing use of computed tomography (CT) have greatly increased the detection of incidental findings, including tiny pulmonary nodules. The management of many "incidentalomas" is significantly influenced by a patient's history of cancer. The study aim is to determine if CT requisitions include prior history of malignancy.

METHODS

Requisitions for chest CTs performed at our adult tertiary care hospital during April 2012 were compared to a cancer history questionnaire, administered to patients at the time of CT scan. Patients were excluded from the study if the patient questionnaire was incomplete or if the purpose of the CT was for cancer staging or cancer follow-up.

RESULTS

A total of 569 CTs of the chest were performed. Of the 327 patients that met inclusion criteria, 79 reported a history of cancer. After excluding patients for whom a history of malignancy could not be confirmed through a chart review and excluding nonmelanoma skin cancer, dysplasia, and in situ neoplasm, 68 patients were identified as having a history of malignancy. We found 44% (95% confidence interval [0.32-0.57]) of the chest CT requisitions for these 68 patients did not include the patient's history of cancer. Of the malignancies that were identified by patient questionnaire but omitted from the clinical history provided on the requisitions, 47% were malignancies that commonly metastasize to the lung.

CONCLUSIONS

A significant number of requisitions failed to disclose a history of cancer. Without knowledge of prior malignancy, radiologists cannot comply with current guidelines regarding the reporting and management of incidental findings.

Variations in Magnetic Resonance Imaging Provision and Processes Among Canadian Academic Centres

PURPOSE

Increasing demand has led to questions regarding the appropriateness of advanced imaging exams, particularly for magnetic resonance imaging (MRI). The study aimed to explore variability in MRI service provision and request variation within Canadian academic medical imaging departments, particularly factors potentially affecting appropriate MRI service provision.

METHODS

All Canadian academic centres with medical imaging residency programs were invited to participate. Participation involved completing an institution-level survey and submitting exam requests for all MRI exams completed in a common 24-hour period. The surveys and request forms were analysed and contrasted.

RESULTS

The 13 participating institutions reported scanner operating hours per week ranging from 101-672; large urban centres typically had higher hours. A total of 42% of sites housed multiple scanners, and 28% housed a 3-T scanner. Most accept requests from all general practitioners and specialists. Only 1 institution has a solely electronic request submission process. Requisitions are focused on patient safety, including contrast considerations, metallic foreign bodies, and implants. Request prioritization scales vary substantially across institutions. Few use referral guidelines to evaluate request appropriateness.

CONCLUSIONS

Our analysis showed great variation among facility-level factors such as hours of operation, request forms, and prioritization scales among institutions and facilities. Opportunities exist to create standardized processes and improve request forms to focus more on specific information required for appropriateness, increase consistency in patient care, and promote demand balancing, minimizing unnecessary exams and therefore reducing wait times.

Software solutions alone cannot guarantee useful radiology requests

Background The availability of clinical information and a pertinent clinical question can improve the diagnostic accuracy of the imaging process. Purpose To examine if an electronic request form forcing referring clinicians to provide separate input of both clinical information and a clinical question can improve the quality of the request. Material and Methods A total of 607 request forms in the clinical worklists for a computed tomography (CT) scan of the thorax, the abdomen or their combination, were examined. Using software of our own making, we examined the presence of clinical information and a clinical question before and after the introduction of a new, more compelling order method. We scored and compared the quality of the clinical information and the clinical question between the two systems and we examined the effect on productivity. Results Both clinical information and a clinical question were present in 76.7% of cases under the old system and in 95.3% under the new system ( P < 0.001). Individual characteristics of the clinical information and the clinical question however, with the exception of incompleteness, showed little improvement under the new system. There was also no significant difference between the two systems in the number of requests requiring further search. Conclusion The introduction of electronic radiology request forms compelling referring clinicians to provide separate input of clinical information and a clinical question provides only limited benefit to the quality of the request. Raising awareness among clinicians of the importance of a well-written request remains essential.

Is the devil in the detail? The quality and clinical impact of information provided on requests for non-trauma emergency abdominal CT scans

BACKGROUND

The role of the radiology information system in streamlining imaging workflow and enhancing efficiency in digital radiology departments is now well established. Although there is increasing use of systems with the capacity for computerized physician order entry, there has been limited work on the quality of clinical data provided on electronic diagnostic imaging requests.

PURPOSE

To assess the quality of clinical details provided on electronic diagnostic imaging requests (DIR) for emergency non-trauma abdominal computed tomography (CT) scans, and the impact of such data on radiological outcomes.

MATERIAL AND METHODS

We conducted a retrospective analysis of 100 consecutive electronic DIRs for emergency non-trauma abdominal CT scans for patients with an acute abdomen in a tertiary-level public-sector hospital. The quality of clinical data was assessed using the Royal College of Physicians' referral guidelines and correlated with radiological outcomes, defined as a definitive CT diagnosis.

RESULTS

Eighty-eight percent of requests presented a clear clinical question, 48% recorded clinical examination details, 29% had adequate clinical histories, and 17% included laboratory investigations, while only 2% of requests were complete in all respects. Although 88% of scans yielded a definitive radiological diagnosis, there was no association between the adequacy of DIR details and a definitive radiological outcome.

CONCLUSION

Our findings underscore the non-specific clinical presentation of non-trauma-related abdominal emergencies and the pivotal role of CT in providing a definitive diagnosis in this setting. We suggest that the appropriate triage of patients presenting with an acute, non-trauma abdomen is the overriding clinical imperative.

Rates of provision of clinical information in the skin biopsy requisition form and corresponding encounter visit note

BACKGROUND

The skin biopsy requisition form (RF) serves as a key communication tool for transfer of relevant information related to skin biopsy between clinicians and pathologists. Clinical information in the skin biopsy RF is frequently missing or incomplete.

OBJECTIVE

To determine the rates of provision of critical clinical information necessary for histopathologic interpretation in the skin biopsy RF and encounter visit note (EVN).

METHODS

A retrospective review of 300 RFs and corresponding EVNs from May 1 to 7, 2012, in a tertiary care dermatology practice.

RESULTS

Age (100%), lesion location (100%), and clinical impression (93%) were the most commonly supplied elements in the RF and EVN. Clinical elements that were commonly not provided in the RF but present in the EVN included sampling method - partial versus complete (46%), duration of lesion (54%), morphology of lesion (97%), clinical symptoms (63%), clinical photos (63%), previous clinical (97%), and dermatopathologic diagnoses (82%).

LIMITATIONS

Retrospective study design.

CONCLUSIONS

These data suggest that while missing critical clinical information in the RF is often present in the EVN, some information is still not present in either source.

Impact of a computerized provider radiography order entry system without clinical decision support on emergency department medical imaging requests

BACKGROUND AND OBJECTIVE

The adoption of computerized physician order entry is an important cornerstone of using health information technology (HIT) in health care. The transition from paper to computer forms presents a change in physicians' practices. The main objective of this study was to investigate the impact of implementing a computer-based order entry (CPOE) system without clinical decision support on the number of radiographs ordered for patients admitted in the emergency department.

METHODS

This single-center pre-/post-intervention study was conducted in January, 2013 (before CPOE period) and January, 2014 (after CPOE period) at the emergency department at Nîmes University Hospital. All patients admitted in the emergency department who had undergone medical imaging were included in the study.

RESULTS

Emergency department admissions have increased since the implementation of CPOE (5388 in the period before CPOE implementation vs. 5808 patients after CPOE implementation, p=.008). In the period before CPOE implementation, 2345 patients (44%) had undergone medical imaging; in the period after CPOE implementation, 2306 patients (40%) had undergone medical imaging (p=.008). In the period before CPOE, 2916 medical imaging procedures were ordered; in the period after CPOE, 2876 medical imaging procedures were ordered (p=.006). In the period before CPOE, 1885 radiographs were ordered; in the period after CPOE, 1776 radiographs were ordered (p<.001). The time between emergency department admission and medical imaging did not vary between the two periods.

CONCLUSIONS

Our results show a decrease in the number of radiograph requests after a CPOE system without clinical decision support was implemented in our emergency department.