title: Reducing inappropriate diagnostic practice through education and decision support.
abstract: 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.
authors.affiliation: Division of Imaging Services, Royal Perth Hospital, Wellington Street, Perth, Australia. phillip.bairstow@health.wa.gov.au
authors.forename: Phillip James
authors.initials: PJ
authors.lastname: Bairstow
authors.forename: Jennifer
authors.initials: J
authors.lastname: Persaud
authors.forename: Richard
authors.initials: R
authors.lastname: Mendelson
authors.forename: Long
authors.initials: L
authors.lastname: Nguyen
mesh_terms: 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