Closing the Loop on Unscheduled Diagnostic Imaging Orders: A Systems-Based Approach.

PURPOSE: The aims of this study were to (1) describe the System for Coordinating Orders for Radiology Exams (SCORE), the objective of which is to manage unscheduled orders for outpatient diagnostic imaging in an electronic health record (EHR) with embedded computerized physician order entry; (2) assess the impact of SCORE and other related factors (eg, demographics) on the rate of unscheduled orders; and (3) assess the clinical necessity of orders canceled, expired, scheduled, and performed. METHODS: This institutional review board-approved retrospective study was conducted at a large academic institution between October 1, 2017, and July 1, 2019. The design and implementation of SCORE are described, including people (eg, competencies), processes (eg, standardized procedures), and tools (eg, EHR interfaces, dashboard). The rate of unscheduled imaging orders was compared before SCORE (October 1, 2017, to September 30, 2018) and after SCORE (October 1, 2018, to Jun 30, 2019) using χ2 analysis. For 447 randomly selected orders, mode of resolution was obtained from the EHR, and factors related to order resolution were assessed using multivariate analysis. Finally, clinical necessity was manually assessed by two physicians. RESULTS: Before SCORE, 52,204 of 607,020 examination orders (8.6%) were unscheduled, compared with 20,900 of 475,000 examination orders (4.4%) after SCORE (P < .00001, χ2 test), a 49% reduction in unscheduled orders. Among 447 randomly selected orders, orders were addressed via cancellation (57%), expiration (21%), scheduling (1%), and performance (11%). Order resolution was not significantly associated with other factors. About 32% of cancellations and 27.7% of expired orders remained clinically necessary, which was attributed to scheduling and patient-related factors. CONCLUSIONS: SCORE significantly reduced unscheduled diagnostic imaging orders. This patient safety initiative may help reduce errors resulting from diagnostic delays due to unscheduled examination orders.

Importance of Interprofessional Healthcare for Vulnerable Refugee Populations.

The refugee population in the United States is steadily increasing. These populations face a plethora of diseases and chronic health problems (i.e. obesity, hypertension and depression) as they resettle into their new environment. Due to the lack of understanding, minority population refugee health is scarce and minimal at best. Refugees and healthcare professionals face similar barriers when it comes to seeking treatment and treatment itself. For example, refugees might not be able to communicate efficiently and understand the referral process while healthcare professionals do not understand the culture and language of their patients. However, more data is needed to determine if interprofessional teams consisting of differing healthcare professionals such as nurses, pharmacists, and dieticians that conduct home visits might be able to bridge the health care gap between individualized treatment and refugee needs.