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.