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Original article
peer-reviewed

Failure of Real-time Passive Notification about Radiation Exposure to Influence Physician Ordering Behavior



Abstract

Objectives 

To determine whether real-time passive notification of patient radiation exposure via a computerized physician order entry system would alter the number of computed tomography scans ordered by physicians in the Emergency Department (ED) setting.

Methods 

When a practitioner ordered a computed tomography scan, a passive notification was immediately and prominently displayed via the computerized physician order entry system. The notification stated the following: the amount of estimated radiation in millisieverts (mSv), the equivalent number of single-view chest radiographs, and equivalent days of average environmental background radiation to which a patient during a specific computed tomography scan would be exposed. The primary outcome was changed in the number of computed tomography scans ordered when comparing data collected before and after the addition of the notification.

Results 

Before the dosimetry notification (“intervention”) was instituted, 1,747 computed tomography scans were performed on patients during 11,709 Emergency Department visits (14.9% computed tomography scan rate). After the intervention had been instituted, 1,827 computed tomography scans were performed on patients during 11,582 Emergency Department patient visits (15.8% computed tomography scan rate). No statistically significant difference was found for all chief complaints combined (p = 0.17), or for any individual chief complaint, between the number of computed tomography scans performed on Emergency Department patients before versus after the intervention.

Conclusions 

Passive real-time notification of patient radiation exposure displayed in a computerized physician order entry system at the time of computed tomography scan ordering in the Emergency Department did not significantly change the number of ordered scans. 



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Original article
peer-reviewed

Failure of Real-time Passive Notification about Radiation Exposure to Influence Physician Ordering Behavior


Author Information

Lauren A. Polen

Emergency Medicine, California Pacific Medical Center, San Francisco

Jennifer K. Rossi

Emergency Medicine, Oregon Health

Cameron K. Berg

Emergency Medicine, North Memorial Healthcare

Raymond R. Balise

Department of Public Health, Division of Biostatistics, University of Miami Health System

Robert J. Herfkens

Radiology, Stanford University School of Medicine

Paul S. Auerbach Corresponding Author

Department of Emergency Medicine, Stanford University School of Medicine


Ethics Statement and Conflict of Interest Disclosures

Human subjects: Consent was obtained by all participants in this study. Stanford University Institutional Review Board issued approval IRB22216. Animal subjects: This study did not involve animal subjects or tissue. Conflicts of interest: The authors have declared that no conflicts of interest exist.


Original article
peer-reviewed

Failure of Real-time Passive Notification about Radiation Exposure to Influence Physician Ordering Behavior


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Original article
peer-reviewed

Failure of Real-time Passive Notification about Radiation Exposure to Influence Physician Ordering Behavior

  • Author Information
    Lauren A. Polen

    Emergency Medicine, California Pacific Medical Center, San Francisco

    Jennifer K. Rossi

    Emergency Medicine, Oregon Health

    Cameron K. Berg

    Emergency Medicine, North Memorial Healthcare

    Raymond R. Balise

    Department of Public Health, Division of Biostatistics, University of Miami Health System

    Robert J. Herfkens

    Radiology, Stanford University School of Medicine

    Paul S. Auerbach Corresponding Author

    Department of Emergency Medicine, Stanford University School of Medicine


    Ethics Statement and Conflict of Interest Disclosures

    Human subjects: Consent was obtained by all participants in this study. Stanford University Institutional Review Board issued approval IRB22216. Animal subjects: This study did not involve animal subjects or tissue. Conflicts of interest: The authors have declared that no conflicts of interest exist.

    Acknowledgements


    Article Information

    Published: July 15, 2016

    DOI

    10.7759/cureus.695

    Cite this article as:

    Polen L A, Rossi J K, Berg C K, et al. (July 15, 2016) Failure of Real-time Passive Notification about Radiation Exposure to Influence Physician Ordering Behavior . Cureus 8(7): e695. doi:10.7759/cureus.695

    Publication history

    Received by Cureus: May 24, 2016
    Peer review began: June 08, 2016
    Peer review concluded: July 12, 2016
    Published: July 15, 2016

    Copyright

    © Copyright 2016
    Polen et al. This is an open access article distributed under the terms of the Creative Commons Attribution License CC-BY 3.0., which permits unrestricted use, distribution, and reproduction in any medium, provided the original author and source are credited.

    License

    This is an open access article distributed under the terms of the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original author and source are credited.

Abstract

Objectives 

To determine whether real-time passive notification of patient radiation exposure via a computerized physician order entry system would alter the number of computed tomography scans ordered by physicians in the Emergency Department (ED) setting.

Methods 

When a practitioner ordered a computed tomography scan, a passive notification was immediately and prominently displayed via the computerized physician order entry system. The notification stated the following: the amount of estimated radiation in millisieverts (mSv), the equivalent number of single-view chest radiographs, and equivalent days of average environmental background radiation to which a patient during a specific computed tomography scan would be exposed. The primary outcome was changed in the number of computed tomography scans ordered when comparing data collected before and after the addition of the notification.

Results 

Before the dosimetry notification (“intervention”) was instituted, 1,747 computed tomography scans were performed on patients during 11,709 Emergency Department visits (14.9% computed tomography scan rate). After the intervention had been instituted, 1,827 computed tomography scans were performed on patients during 11,582 Emergency Department patient visits (15.8% computed tomography scan rate). No statistically significant difference was found for all chief complaints combined (p = 0.17), or for any individual chief complaint, between the number of computed tomography scans performed on Emergency Department patients before versus after the intervention.

Conclusions 

Passive real-time notification of patient radiation exposure displayed in a computerized physician order entry system at the time of computed tomography scan ordering in the Emergency Department did not significantly change the number of ordered scans. 



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Lauren A. Polen

Emergency Medicine, California Pacific Medical Center, San Francisco

Jennifer K. Rossi

Emergency Medicine, Oregon Health

Cameron K. Berg

Emergency Medicine, North Memorial Healthcare

Raymond R. Balise

Department of Public Health, Division of Biostatistics, University of Miami Health System

Robert J. Herfkens

Radiology, Stanford University School of Medicine

Paul S. Auerbach, M.D., Other

Department of Emergency Medicine, Stanford University School of Medicine

For correspondence:
paul.auerbach@gmail.com

Lauren A. Polen

Emergency Medicine, California Pacific Medical Center, San Francisco

Jennifer K. Rossi

Emergency Medicine, Oregon Health

Cameron K. Berg

Emergency Medicine, North Memorial Healthcare

Raymond R. Balise

Department of Public Health, Division of Biostatistics, University of Miami Health System

Robert J. Herfkens

Radiology, Stanford University School of Medicine

Paul S. Auerbach, M.D., Other

Department of Emergency Medicine, Stanford University School of Medicine

For correspondence:
paul.auerbach@gmail.com