Clinical decision support to reduce laterality ordering errors for breast imaging procedures.

Abstract

241 Background: Data showed 46 modifications to breast imaging orders upon patient arrival to the Radiology Department, in a 4 month period (Sept-Dec 2014.) Upon further investigation, we found that patients were arriving in radiology, scheduled for exams for which the laterality needed to be modified prior to the exam. (The most frequent occurrence was a patient with a history of a unilateral mastectomy, arriving in radiology for a bilateral mammogram.) These laterality order errors were traced back to either the referring LIP requesting the exam, or to the referring office’s clerical staff transcribing the order. The ordering errors came from many different referring services. Methods: Our objective was to develop Clinical Decision Support in our Clinical Information System (CIS,) to offer an upfront alert of a potentially incorrect laterality when a user was entering or transcribing an order, prompting the user to confirm that the correct exam had been ordered before scheduling took place. The Health Informatics team developed a Medical Logic Module (MLM) in CIS which cross-checks the surgical history in the Clinical Documentation Operative Notes with the current CIS order; if a mismatch is found, the alert fires. Results: In the first 2 months (Dec 2016-Jan 2017), 110 alerts were generated. Fifty-seven alerts flagged users of incorrect orders which were corrected before being scheduled; 21 MLM alerts were acknowledged and comments entered explaining the need for the test; 32 alerts did not generate an order (and in most of these instances, the user backed out and entered the incorrect order again; upon the second time seeing the alert, they changed the order, resulting in many of the 57 changed orders referenced above). Conclusions: The MLM alert allows for immediate feedback to the user entering an order with a potentially incorrect laterality. Not only does this reduce the time and burden associated with investigating and modifying these orders upon patient arrival; more importantly, it ensures orders are entered correctly from the start, reducing the possibility of an incorrect exam taking place.