Patterns of use of cervical spine decision rules installed in EHR imaging order [abstract]
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Background: The use of computerized decision support for advanced imaging orders is required in some outpatient settings but not yet in the ED. Validated clinical decision rules are shown to help guide the ordering decision of cervical spine CT imaging. Objectives: We sought to determine if providers would voluntarily use newly embedded decision rules within a cervical spine CT electronic order more frequently than the standard method of order entry. We also had interest in which rule providers preferred when both were available. Methods: At three hospitals, the cervical spine CT order was updated in a quality improvement project to include questions from the Canadian and NEXUS cervical spine decision rules. In each order, providers could answer questions from either rule to satisfy the order indications requirements. They could alternatively use a ‘rule not appropriate’ option to apply the standard method of documenting imaging indications required by the radiology department. Data were collected from each cervical spine CT order placed by ED attending physicians, residents or physician assistants during the review period. Descriptive statistics determined the proportion of orders in which the ordering provider used a decision support rule or opted out of using the rule. Results: From 9/1/2014 thru 8/31/2015, 2022 orders were placed meeting the inclusion criteria. The ordering provider documented the use of a rule in 1257 (62%) orders. When stratified by provider role, attending physicians chose to use the rule less than half of the time (48%), whereas physician assistants and residents chose to use the rule more frequently (64% and 74%, respectively). When a rule was used, the Canadian rule was used in 638 (51%) orders and the NEXUS rule in 619 (49%) orders. The table details the breakdown of all orders placed by provider role. Conclusion: When asked to enter indications for a c-spine CT order, providers opt to use a decision rule more frequently than the standard method of order entry. However, attending physicians used the rule less frequently when compared to physician assistants or residents. Providers who used a decision rule chose the Canadian rule and the NEXUS rule with similar frequency.