orders in radiology a physician’s view iain keeping md frcp patient safety lead filetek uk for...
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Orders in Radiologya physician’s view
Iain Keeping MD FRCP
Patient safety lead Filetek UK for Meditech
Scope
Usability
Patient safety
Orders in OPD and on the ward
Credentials
NHS respiratory specialist, Chester 25yrs
Procurement of integrated system 1995 - 1999Implementation 1999 - 2007Radiology first module to be implementedInpatient and outpatient ordering 2000
Paper based ordering
Time consumingmultiplicity of formsduplicity of information
+ biochemistry + haematology + procedures + consent
= fraught physician!
Paper based ordering
•Illegible•Light on clinical information•Inaccurate•Easily lost
BUT
anyone else can do it for you!
Electronic ordering
•Easy search for patient record•Single ordering process for everything •Easy location of test•Order sets?•Intuitive names of tests•Prevention of duplicate orders
Ideally
Electronic ordering
•Legibility – not much impact•Clinical information – forced to give it•Accuracy – patient demographics, location •Will not be lost
Advantages (physician’s view)
Definitely fasterOrder remains part of the EPR for all to see
BUT few can do it for you
The Big Issues
•Juniors are no problem•“Big bang” is best•Early clinical ownership•Destroy ALL paper request forms overnight•Lock away down-time request paper forms
Getting doctors to use it
The Big Issues
•Barcode readers – limited value, better in OPD•Define dictionaries to suit the requester•Decide on order sets in advance•Role of nurses?
Make access simple
The Big Issues
•Loathed by ordering doctors•Beloved of radiographers•Resolved in Chester to: “Could the patient be pregnant?”
The LMP question
The Big Issues
•No irrelevant questions•Complex questions are justifiable eg CTPA
Structure the order to suit the test
The Big Issues
•Cancer referrals ?CT request without seeing the patient•Follow-up inpatient and outpatient
Pre-ordering
The Big Issues
Eg “Please investigate for pulmonary embolism”
Let the imaging department decide on the relevant tests
Consider “advanced” ordering
The Big Issues
The receipt of the report and its acknowledgement
- but the biggest is:
Patient safety, ordering
Wrong patient selectionAll the risks relate to the report
Very few risks:
Patient safety, reporting
•Who receives the report?•What happens when an emergency inpatient is transferred? •How is the report acknowledged?•What is acknowledged?•What happens when the requester is not around?•What happens when an inpatient is discharged?•Where does the reporter’s responsibility stop?•What action has been taken?
When all of these have been answered for all working
practices then the paper report could be switched off.
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