Have a pressing reason to override a recommendation from clinical decision support? What if you were asked to prove it? Requiring justification to override alerts reduced the number of repeat CT scans, according to a study published in the American Journal of Roentgenology.
Led by Stacy D. O’Connor of Brigham and Women’s Hospital in Boston, the research team sought to look into potentially preventing some of the $226 billion of overuse costs in healthcare in the U.S., specifically concentrating on medically unnecessary repeat CT scans—known sources of potentially harmful ionizing radiation.
Electronic clinical decision support issues an alert to the ordering medical staff if the patient’s same body part has undergone a CT scan in the last 90 days. For the study, overriding the alert required clinical justification selected from a predetermined menu, otherwise the repeat CT scan order could not be placed and would be dropped.
The final study cohort was 28,420 CT orders that triggered repeat imaging alerts between January and December 2010. Repeat CT orders were begun for 6,800 unique preintervention patients and 9,460 postintervention patients.
“Requiring clinical justification to override or ignore a repeat CT clinical decision support alert was associated with the elimination of one in 13 CT orders in patients who underwent CT of the same body part in the previous 90 days,” O’Connor and colleagues wrote.
The results found that completed repeat CT orders accounted for 22 percent of all completed CT orders in the study timeframe.
The study intervention of requiring a clinical justification for a repeat CT scan was also associated with an average of 35 fewer CT orders being placed each month. These interventions, the authors wrote, may be generally applicable in helping change physician behavior to improve quality and reduce waste.
"Our findings also strengthen the evidence that CDS-enabled interventions can serve as useful tools to decrease health care costs and increase appropriateness of care,” O’Connor and colleagues wrote.