title: Failure of Real-time Passive Notification about Radiation Exposure to Influence Physician Ordering Behavior.
abstract: Objectives  To determine whether real-time passive notification of patient radiation exposure via a computerized physician order entry system would alter the number of computed tomography scans ordered by physicians in the Emergency Department (ED) setting. Methods  When a practitioner ordered a computed tomography scan, a passive notification was immediately and prominently displayed via the computerized physician order entry system. The notification stated the following: the amount of estimated radiation in millisieverts (mSv), the equivalent number of single-view chest radiographs, and equivalent days of average environmental background radiation to which a patient during a specific computed tomography scan would be exposed. The primary outcome was changed in the number of computed tomography scans ordered when comparing data collected before and after the addition of the notification. Results  Before the dosimetry notification ("intervention") was instituted, 1,747 computed tomography scans were performed on patients during 11,709 Emergency Department visits (14.9% computed tomography scan rate). After the intervention had been instituted, 1,827 computed tomography scans were performed on patients during 11,582 Emergency Department patient visits (15.8% computed tomography scan rate). No statistically significant difference was found for all chief complaints combined (p = 0.17), or for any individual chief complaint, between the number of computed tomography scans performed on Emergency Department patients before versus after the intervention. Conclusions  Passive real-time notification of patient radiation exposure displayed in a computerized physician order entry system at the time of computed tomography scan ordering in the Emergency Department did not significantly change the number of ordered scans.
authors: Emergency Medicine, California Pacific Medical Center, San Francisco.
authors: Lauren A
authors: LA
authors: Polen
authors: Emergency Medicine, Oregon Health.
authors: Jennifer K
authors: JK
authors: Rossi
authors: Emergency Medicine, North Memorial Healthcare.
authors: Cameron K
authors: CK
authors: Berg
authors: Department of Public Health, Division of Biostatistics, University of Miami Health System.
authors: Raymond R
authors: RR
authors: Balise
authors: Radiology, Stanford University School of Medicine.
authors: Robert J
authors: RJ
authors: Herfkens
authors: Department of Emergency Medicine, Stanford University School of Medicine.
authors: Paul S
authors: PS
authors: Auerbach
keywords: computed tomography scanning; physician ordering; radiation exposure