Mandating radiologists use computerized physician order entry (CPOE) for contrast media does not negatively affect the rate of oral contrast use for inpatient abdominopelvic CT, but that doesn’t mean radiologists will like it, according to a retrospective, single-center study published in the March issue of the American Journal of Roentgenology .
“CPOE continues to gain acceptance in the medical community and is increasingly used as a means to reduce errors and improve patient care. It is not without faults, however, and not all CPOE mechanisms are necessarily beneficial,” wrote authors Matthew S. Davenport, MD, of the University of Michigan, Ann Arbor, and colleagues.
To see if a mandate to use CPOE affects the use of oral contrast for CT, the authors conducted a study of a large academic institution which began requiring practicing radiologists to manually enter orders for oral contrast media used during CT. Rates of both oral and IV contrast material use were examined for the six months prior to implementing CPOE in May 2010 and for the six months after.
A protocol that normally includes oral or IV contrast administration was used for 1,693 CT exams during the study period, with 784 performed before implementation of CPOE and the rest performed after implementation. Results showed no significant change in the ratios of indications for CT, rates of use of IV contrast or rates of oral contrast use after CPOE was implemented.
While CPOE implementation had no effect on the rate of oral contrast media use, a survey of radiologists’ perceptions of the new system showed they were less than thrilled about the changes to workflow.
“The CPOE system used during the study period was not well received by the practicing radiologists,” wrote the authors. “The survey data showed that a large minority of radiologists (43 percent) believed that the CPOE requirement was either very disruptive or extremely disruptive to their workday. One radiologist admitted to willful avoidance of the system.”
While there was a measurable effect on order entry time, a comparison of the radiologist surveys and actual ordering times showed most respondents overestimated the length of time it took to enter an oral contrast order. The perceived time loss was an average of 183 seconds per order, compared with the actual average of 107 seconds. In addition to finding the CPOE process time-consuming, only 2 percent of the respondents felt that having radiologists enter orders for oral contrast improved patient safety.
“Although on a per-patient basis the time cost was nominal (i.e., the delay imparted by having a radiologist use CPOE to order oral contrast material likely did not contribute to a substantial delay in patient care), the mean estimated daily physician time expenditure was 8 minutes 44 seconds. This value extrapolated to an estimated physician time loss of 26 hours 38 minutes during the post-CPOE period,” summed Davenport et al.
The authors suggested some steps that could be taken to reduce the time lost to CPOE. Installing a computer workstation in the reading room that is directly connected to the hospital network would have reduced half of the time loss observed in the study. The order entry process could also be streamlined to include automatic prompts allowing radiologists to select contrast media type when ordering a CT exam.