Diagnostic imaging ordering practices: physician perspectives and implications for decision support

Date

2014-04

Authors

Griffith, Janessa K.
Borycki, Elizabeth M.
Kushniruk, Andre

Journal Title

Journal ISSN

Volume Title

Publisher

Longwoods Publishing

Abstract

This study explored how referring physicians order diagnostic imaging (DI) services, and possible methods to reduce inappropriate ordering. Telephone interviews were conducted with non-radiologist physicians (general practitioners and specialists). Interview data were analyzed using grounded theory. Both appropriate and inappropriate DI ordering practices emerged as the overarching themes. Specifically, the majority of participants described their top methods of obtaining information support as (1) contacting another physician or (2) consulting the literature. Additionally, participants discussed contributing factors and solutions to inappropriate DI ordering, including clinical decision support systems. These results were used to inform the design of a DI decision support system prototype. This study explored ways to reduce inappropriate DI ordering and identified socio-technical factors that need to be considered when developing ways to mitigate this phenomenon. Promoting more appropriate ordering can improve patient safety and the responsible use of limited diagnostic imaging resources. Research in diagnostic imaging (DI) ordering practices can help to promote patient safety and the responsible use of limited healthcare resources by reducing unnecessary DI examinations. While research relating to why physicians may order inappropriately is present in the literature, how physicians order DI remains unclear. Using key informant interviews, this study aimed to explore this knowledge gap. From the interview data, ordering (both appropriate and inappropriate) emerged as the overarching themes. This included several subthemes: what methods of information support a physician would seek during a challenging clinical scenario, and contributing factors and solutions to inappropriate ordering. These findings included the physician perspective on how information technology (IT; such as clinical decision support [CDS] systems) could be used to reduce inappropriate DI ordering. Findings were compared and contrasted to the current literature surrounding DI. With recent increases in DI use, examining ways to reduce unnecessary examinations is crucial in order to promote patient safety and the responsible use of DI resources.

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Citation

Griffith, J.K., Borycki, E.M. & Kushniruk, A.W. 2014, "Diagnostic imaging ordering practices: physician perspectives and implications for decision support", Healthcare quarterly (Toronto, Ont.), vol. 17, no. 2, pp. 62.