Background: The STAT priority in imaging is universally understood as a signal for medical emergencies; however, its misuse is widespread. At our institution, prior to intervention, 45% of all imaging exams were ordered STAT, with many of these orders not indicating medical emergencies. Our previous initiative in 2023 aimed to redefine imaging priority categories, reserving STAT for true emergencies, ASAP for urgent cases requiring intervention, and Routine for investigative exams. Using CT head as a test case, we demonstrated reduction in the percentage of Head CT’s ordered STAT from 92% to 78% and decreased STAT turnaround time (TAT) by one hour. This success led to the expansion of these efforts across multiple imaging modalities, including MRI and Chest X-ray.
Purpose: Our project aimed to improve the accuracy of imaging priority classifications, specifically for MRI and Chest X-ray orders, ensuring that STAT priority was reserved for true medical emergencies. Our second aim was to improve STAT and ASAP TAT to ensure patients with true medical emergencies received timely exams
Description: A multidisciplinary team was formed, consisting of radiology leadership, inpatient physicians, radiology technicians, and IT support. The team assessed imaging modalities with high STAT ordering percentages, narrowing our focus to MRI brain, MRI cervical/thoracic/lumbar spine (CTL), and Chest X-ray. Through process mapping of the order-entry to exam-start times, we identified significant delays, particularly in the MRI screening and pacemaker form completion process. We addressed these issues by converting both forms into EMR based solutions and conducting education sessions for nurses and electrophysiologists. No significant delays were identified for Chest X-ray orders. We excluded images ordered in the emergency department and operating rooms. We introduced an attestation system in the EMR order workflow for MRI brain and MRI CTL spine, prompting providers to indicate whether they had concerns for imminent neurological compromise. This response automatically adjusted the order priority, filling STAT if a concern was present, or Routine if not. Additionally, an ASAP option was created for cases requiring immediate treatment or surgery. Similarly, for Chest X-rays, we implemented a question to determine if the order was due to a “critical or life-threatening condition,” which would automatically set the order as STAT.We monitored order accuracy, priority, and time-to-completion through a dashboard, allowing for trending and feedback.Post-implementation, there was improvement in TAT across both MRI and Chest X-ray orders. STAT orders decreased by an average of 10%, while ASAP orders increased by an average of 12% indicating greater adoption of appropriate imaging priorities. The overall TAT showed an average 0.35hr reduction, reflecting improved efficiency in imaging completion (Table 1).
Conclusions: Establishing clear institutional definitions for imaging priority categories and introducing an ASAP option led to more appropriate use of STAT priority in MRI and Chest X-ray orders. This intervention improved imaging turnaround times and better aligned imaging priorities with clinical needs. Future work will focus on expanding this model to other radiologic modalities, as well as monitoring downstream effects, such as clinical outcomes and quality of care improvements, resulting from more accurate image ordering and timeliness.
