title: Impact of a Four-Point Order-Priority Score on Imaging Examination Performance Times.
abstract: BACKGROUND
  Many hospitals use a traditional categoric system (eg, STAT, ASAP [as soon as possible], routine) to prioritize orders for imaging examination performance. If left undefined, these categories contain ambiguity, which contributes to errant or misused categorizations, and ultimately, lost opportunity to optimally direct resources toward timely patient care. Our hospital implemented ordinal order-priority categories with specific definitions. We sought to determine the impact of this prioritization method on examination performance time and consistency.
  
  
  METHODS
  A four-level numeric priority system with clinical definitions for each category was implemented in 2011 to replace a traditional model for hospital imaging orders. Retrospective analysis was performed on imaging orders for three years (2011-2013) after implementation, to assess the order-to-performance time (OTPT), defined as the time between order placement by the provider and examination completion by the technologist. Consistency was measured by the length of the interquartile range for the OTPT distribution. Comparison was made to orders from the preimplementation year (2010), as a control.
  
  
  RESULTS
  The OTPT and OTPT consistency for performed examinations were both predictably stratified by order-priority level. Relative to control, we observed a reduction in the percentage of prioritized examinations, as well as modest general improvements in OTPT and OTPT consistency.
  
  
  CONCLUSIONS
  A revised order-priority system with ordinal categorizations and clinical definitions accompanying each priority level at order entry yielded desirable prioritization of imaging examination performance by technologists, as evidenced by appropriate stratification of turnaround times and consistency by level of priority.
authors.affiliation: Department of Radiology and Medical Imaging, University of Virginia Health System, Charlottesville, Virginia.
authors.forename: Ryan P
authors.initials: RP
authors.lastname: McWey
authors.affiliation: Department of Radiology and Medical Imaging, University of Virginia Health System, Charlottesville, Virginia.
authors.forename: Michael D
authors.initials: MD
authors.lastname: Hanshew
authors.affiliation: Department of Public Health Sciences, University of Virginia Health System.
authors.forename: James T
authors.initials: JT
authors.lastname: Patrie
authors.affiliation: Department of Radiology and Medical Imaging, University of Virginia Health System, Charlottesville, Virginia.
authors.forename: Dustin M
authors.initials: DM
authors.lastname: Boatman
authors.affiliation: Department of Radiology and Medical Imaging, University of Virginia Health System, Charlottesville, Virginia. Electronic address: cree@virginia.edu.
authors.forename: Cree M
authors.initials: CM
authors.lastname: Gaskin
mesh_terms: D003952:Diagnostic Imaging / Q000706:statistics & numerical data*; D017598:Efficiency, Organizational / Q000706:statistics & numerical data*; D006292:Health Priorities / Q000706:statistics & numerical data*; D010818:Practice Patterns, Physicians' / Q000706:statistics & numerical data*; D011871:Radiology / Q000706:statistics & numerical data*; D013996:Time and Motion Studies; D014768:Virginia; D000066477:Work Performance / Q000706:statistics & numerical data; D016526:Workload / Q000706:statistics & numerical data*
keywords: Examination prioritization; order priority; performance times; turnaround times