Radiology department uses a systems-based approach to reduce unscheduled imaging orders by 49%

The radiology field has experienced ongoing challenges with leaving clinically necessary imaging exams unscheduled, presenting possible risks to patient health. But Harvard Medical School clinicians have found a solution that’s beginning to make a dent in this problem.

Experts with the institution recently detailed their System for Coordinating Orders for Radiology Exams, or SCORE, in JACR. The institution-wide, multidisciplinary intervention functions as a backstop for patients unable to close the loop on their imaging work in a timely fashion.

It works by tracking all patients with scheduled radiologic exams—ordered for acute or episodic care, and ongoing disease management—and detects and manages orders that aren’t resolved. Analyzing SCORE’s use over a nearly two-year period, researchers found the system dropped unscheduled orders by almost half.  

“Monitoring these orders to completion can be complicated and labor intensive. Nevertheless, addressing these unscheduled orders are essential to patient safety,” Ronilda Lacson, MD, PhD, director of education with the Center for Evidence-Based Imaging at Brigham and Women’s Hospital, and colleagues wrote Oct. 5. “SCORE is meant to provide a ‘safety net,’ providing a redundant system to assist care coordinators in ordering and scheduling appropriate tests.”

In a nutshell, SCORE operates by deploying care managers to monitor all imaging orders each day, making sure that they’re resolved. They utilize different statuses including performed, scheduled, canceled and expired. For the latter, coordinators send an electronic alert to providers with the option to reorder an exam, if needed. If a patient can’t be reached after three tries, an order is deferred for 28 days, and a letter is sent to the patient. If still unreachable at that point, the order is canceled and a message is sent to the provider.

Lacson et al. measured SCORE’s success by conducting a retrospective study between October 2017 and July 2019, comparing outcomes before and after the system was implemented. They also selected 447 random orders, pinpointing the mode of resolution and factors that led to the delay.

Prior to SCORE, the institution tallied 52,204 unscheduled orders (or 8.6%), which dropped down to 20,900 (4.4%) after the intervention. That represents a 49% decrease, the team noted.

Among the random sample, orders were resolved via cancellation (57%), expiration (21%), scheduling (1%) and performance (11%). Roughly 32% of the cancellations and 27.7% of expired orders remained clinically necessary, which Lacson and colleagues attributed to scheduling and patient-related factors.

Meanwhile, 98% of performed imaging exams and 83.3% of scheduled exams were found to be medically necessary.

“This is reassuring because inappropriate diagnostic imaging is a national concern given the wide variation in high-cost imaging utilization,” the team noted.

Read more about their results in the Journal of the American College of Radiology here.