The effects on clinician ordering patterns of a computerized decision support system for neuroradiology imaging studies.
OBJECTIVE
To evaluate the impact of computerized ordering guidelines on clinician ordering patterns for neuroradiology imaging studies of the head.


METHODS
A retrospective analysis was performed using a pre-post design. A 9-week control period was followed by an 8-week intervention period.


METHODS
All clinicians who placed an order for either an MRI of the brain or a CT of the head on inpatients using a computerized order entry system.


METHODS
We designed, implemented, and evaluated a decision support system for the implementation of test ordering guidelines. Changes in ordering patterns were evaluated with a Chi-square analysis.


RESULTS
742 tests were ordered in the pre-intervention period, while 704 studies were ordered after the intervention. A significant change in the distribution of tests ordered resulted from the intervention (p=0.048). Changes trended toward the guideline recommendations for all tests considered. 60% of users receiving a recommendation ordered the suggested study.


CONCLUSIONS
Our intervention successfully influenced clinician ordering patterns. Examination of detailed usage patterns may aid in further quality improvement of both the guidelines and the decision support tool used to implement them.
Sanders
D L
DL
Department of Biomedical Informatics, Vanderbilt University Medical Center, Nashville, TN, USA.
Miller
R A
RA
D001921:Brain / Q000000981:diagnostic imaging / Q000473:pathology; D020000:Decision Support Systems, Clinical; D019983:Guideline Adherence / Q000706:statistics & numerical data; D006801:Humans; D008279:Magnetic Resonance Imaging / Q000592:standards / Q000706:statistics & numerical data*; D009485:Neuroradiography / Q000592:standards; D017410:Practice Guidelines as Topic; D010818:Practice Patterns, Physicians' / Q000706:statistics & numerical data*; D012189:Retrospective Studies; D014057:Tomography, X-Ray Computed / Q000592:standards / Q000706:statistics & numerical data*