Reducing inappropriate diagnostic practice through education and decision support.
OBJECTIVE
To quantify non-compliance of diagnostic practice with recommendations in Diagnostic Imaging Pathways and the impact of interventions to reduce non-compliance.


METHODS
Retrospective audits, followed by intervention and re-audits.


METHODS
Emergency department (ED) of Royal Perth Hospital.


METHODS
Six hundred and thirty-eight patients (first audit) and 423 patients (second audit) presenting to the ED with one of the four conditions: suspected pulmonary embolism, ankle injury, suspected renal colic or non-traumatic acute abdominal pain.


METHODS
Education of clinicians on Diagnostic Imaging Pathways recommendations for the four conditions. Decision support through the introduction of request forms, which required 'proof' of adherence to diagnostic pathways.


METHODS
Percentage of patients with a deviation from recommended diagnostic practice.


RESULTS
Overall, 56% of patients had evidence of inappropriate diagnostic practice prior to interventions, with a reduction of 16% following the interventions.


CONCLUSIONS
The reduction was significant but inappropriate practice was not eliminated. For as long as decision-support systems are 'stand-alone' applications, achieving full compliance is dependent on continuous and expensive processes of education and enforcement. A better understanding of why clinicians fail to follow recommended practice is required, and decision support must be better embedded into clinical workflow.
Bairstow
Phillip James
PJ
Division of Imaging Services, Royal Perth Hospital, Wellington Street, Perth, Australia. phillip.bairstow@health.wa.gov.au
Persaud
Jennifer
J
Mendelson
Richard
R
Nguyen
Long
L
D015746:Abdominal Pain / Q000175:diagnosis; D016512:Ankle Injuries / Q000175:diagnosis; D054869:Clinical Audit; D019091:Critical Pathways / Q000458:organization & administration; D003661:Decision Support Techniques; D019937:Diagnostic Techniques and Procedures / Q000706:statistics & numerical data*; D004636:Emergency Service, Hospital / Q000458:organization & administration*; D006801:Humans; D007318:Inservice Training / Q000458:organization & administration; D011655:Pulmonary Embolism / Q000175:diagnosis; D056844:Renal Colic / Q000175:diagnosis; D012189:Retrospective Studies