Background: The STAT priority is understood across the medical community to communicate a medical emergency however misuse of the STAT priority is also widespread1. Previously reported studies have shown that inappropriately ordered STAT radiology images could have a negative impact on patient care2. At our institution, qualitative surveys found that the STAT priority was used by providers to expedite imaging delays, obtain non-urgent radiologic tests prior to discharge, and ensure imaging was complete prior to rounds. This misuse of the STAT priority led to an increased percentage of STAT images with upward of 67% of Head CT orders ordered as STAT for example.
Purpose: Our quality improvement project aimed to improve the ordering accuracy of the imaging priority class by establishing imaging priority definitions and introducing an ASAP priority.
Description: We organized a multidisciplinary team consisting of department of radiology leadership, inpatient physicians, radiology technicians and information technology support. We first completed a gap analysis by surveying inpatient providers (n=141) on their reasons for ordering STAT images. We also used this survey to gather feedback on the proposed priority definitions. Our gap analysis found inconsistent definitions of STAT and reasons for ordering STAT images. Through workgroup consensus, we first defined STAT as an image that is ordered due to “concern for loss of life or limb”. We defined Routine as investigative or non-emergent treatment. We also introduced a new category of ASAP that is defined as required for immediate treatment or surgery. We changed the electronic order to first choose between the attestation “This study IS being ordered due to loss of life or limb- STAT” or “This study is NOT being ordered due to loss of life or limb”. If the STAT option is selected then the STAT priority would auto fill in to the order priority. The number of orders, ordering priority, and the order-to-completion time were monitored using a Qlik dashboard for trending and feedback. We piloted the electronic order change first with the CT Head without contrast as this image had the highest percentage of STAT orders, and a median order-to-completion time of >2 hours. We educated all providers on the new definitions and order changes through flyers and division meetings. One month after the order changed we saw a 58.5% decrease in the number of STAT image orders that was sustained over two months. We also noted an improved median order-to-completion time of < 2 hours. Conversely, we noted an increase in ASAP priority ordering from an average of 3 orders per month to >150. The order-to-completion time for ASAP was < 6 hours sustained over two months.
Conclusions: Establishing an institutional definition for image ordering priorities and introducing an ASAP priority helped improve the appropriate usage of STAT image ordering while reducing the order-to-completion times. As a result, we plan to expand the project to include all radiological tests. Access to timely imaging is key in preventing delays and improving the quality of patient care. In the future, we hope to monitor and report on downstream effects resulting from ordering accuracy and time from order to image completion.
