Quantifying and Reducing Errors in Vascular Imaging Examination Orders Through a Multistage Quality Improvement Intervention

Ariadne K DeSimone; Madhvi Deol; Emma Blassel; Subrina Farah; Ramin Khorasani

doi:10.1016/j.jacr.2023.12.027

Quantifying and Reducing Errors in Vascular Imaging Examination Orders Through a Multistage Quality Improvement Intervention

J Am Coll Radiol. 2024 Jan 2:S1546-1440(23)01046-3. doi: 10.1016/j.jacr.2023.12.027. Online ahead of print.

Authors

Ariadne K DeSimone¹, Madhvi Deol², Emma Blassel², Subrina Farah², Ramin Khorasani³

Affiliations

¹ Brigham and Women's Hospital, Harvard Medical School, Boston, Massachusetts. Electronic address: adesimone@bwh.harvard.edu.
² Brigham and Women's Hospital, Harvard Medical School, Boston, Massachusetts.
³ Vice Chair of Radiology Quality and Safety, Mass General Brigham; and Director of the Center for Evidence-Based Imaging and Vice Chair of Quality/Safety, Department of Radiology, Brigham and Women's Hospital, Harvard Medical School, Boston, Massachusetts.

PMID: 38176671
DOI: 10.1016/j.jacr.2023.12.027

Abstract

Purpose: The aims of this study were to quantify order error rates for vascular imaging examinations and to assess the effects of a multistage quality improvement intervention on those rates.

Methods: In this prospective, institutional review board-exempt project at a large academic quaternary care hospital, the authors aimed to quantify and reduce the order error rate by 50%. The authors analyzed 844 orders for all vascular imaging examinations placed before the intervention (July 19 to August 1, 2021, and September 13 to September 26, 2021), after an intervention in the cardiac surgery department consisting of a new customized order option in the electronic health record for routine preoperative patients (postintervention 1, February 28 to March 27, 2022); and after an educational and feedback campaign (postintervention 2, May 23 to June 5, 2022). Incorrect orders were identified by a radiology trainee during protocoling if the reasons for ordered examination and imaging examination were discordant and subsequently confirmed with the ordering provider. The primary outcome, order error rate, was compared across the project periods using the χ² test and by ordering department using the χ² and Fisher exact tests.

Results: The preintervention order error rate of 16% (50 of 306) decreased by 83% to 3% (10 of 353) at postintervention 1 (P < .001) and was durable at 3% (6 of 185) by project end. Chest CT with or without contrast constituted the majority of incorrect orders (44%, 22 of 50); "Pre-Op" was the most common examination reason (32% [16 of 50]). Cardiac surgery orderers were responsible for the most incorrect orders (32% [16 of 50]). All four most common ordering departments, including cardiac surgery, reduced their order error rates after the intervention (P < .001).

Conclusions: Incorrect orders for imaging examinations can be reduced through targeted quality improvement interventions combining tailored electronic health record order options with education and feedback on practice habits.

Keywords: Medical order entry systems; diagnostic error; imaging order errors; patient safety; quality improvement.