Customized EMR modules can be leveraged to improve the ability of physicians to accurately locate support devices, such as catheters, lines and tubes, on radiography in the intensive care unit (ICU) and beyond, according to an article published in the February issue of the Journal of the American College of Radiology.
Previous research has shown a 1-3 percent rate of catheter misplacement, and malpositioned support devices are often hard to spot on standard portable ICU x-rays due patient positioning or body type, according to Tami J. Bang, MD, of the University of Colorado School of Medicine in Aurora.
“The failure of a radiologist to accurately identify an inappropriately positioned catheter can result in a higher risk for significant patient morbidity,” wrote Bang and colleagues.
The authors were spurred into tackling this issue head-on following a case at the University of Colorado Hospital in which a mispositioned catheter resulted in significant patient morbidity. A multidisciplinary conference was held between the departments of radiology and professional risk management, as well as ICU nursing staff.
“All parties agreed that improved communication among ICU staff members, clinicians, and radiologists could decrease the number of interpretive errors related to tube and line position,” wrote the authors. “Several individuals inquired whether the [EMR] could be used as a tool to facilitate such communication.”
The fix came in the form of an EMR modification, made in conjunction with the hospital’s EMR vendor, in which information on all points of invasive access on each patient can be called up quickly and easily. The nursing staff documents all tubes, catheters and drains in the EMR, and a radio button was added to the radiologist’s reading palette that quickly calls up these notifications.
“When faced with a radiograph with multiple and an often confusing array of catheters and wires, this system allows a radiologist to easily correlate with the list of devices, identify the object(s), and determine if the location is appropriate or not,” wrote Bang and colleagues.
Quantitative data on the outcome of this modification were not yet available, but the authors explained that all three dedicated thoracic radiologists who regularly use the feature say it has improved their ability to confirm the presence and position of life-support devices.
“Although our focus was initially on portable ICU radiography, the accurate identification of support devices on other forms of imaging can also be challenging,” added Bang and colleagues. “This radio button is always enabled, regardless of the type of radiologic examination (eg, plain films, CT, nuclear medicine). The ability of this system to function in all imaging modalities should assist in preventing incorrect interpretations across multiple modalities.”