Download How To 2: Prescribe Right Patient Imaging Protocol

Study Protocoling
Getting it right, for every patient, all the time
Background
• Many patients have to wait a long time to get their imaging study.
• They may have to take time off work, arrange babysitters, drive for very long
distances, or make other sacrifices to get their imaging done.
• Their care may be on hold until the imaging is done and interpreted.
• They may be anxious about the results, or anxious about the procedure.
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If we make mistake, patients may have to be called back.
They may need to be sedated again.
They may get radiated again.
They may receive contrast again.
They may have to deal with anxiety again.
• Let’s not call patient’s back for our mistakes!
Billing issues
• We may not get reimbursed if the imaging protocol we select does not match the
request that was issued by the referring provider.
• Therefore, if we determine that the referring provider should have ordered a
different exam, we need to discuss our recommendation with the referring provider
and obtain a new order (usually must also be pre-authorized).
Medicolegal issues
• Sometimes our scheduling staff transcribes patient history and requested studies
manually into the radiology information system (RIS).
• This can introduce errors.
• The radiologist is legally liable for using the original study request and history when
selecting imaging protocols.
Order
Protocol
What patient
needs
The goal is to determine what the patient needs and
make sure it conforms with the study request
and the selected imaging protocol.
Determine what the patient needs
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Review history provided on the order form
Look up patient chart for more history
Ask patient for more accurate history
Read old reports (history and previous follow-up recommendations)
Avoid errors
Error
Prevention of error
Wrong history transcribed
Review original order request form
Use electronic order entry system
Wrong study scheduled in RIS
Review original order request form
Inappropriate study ordered
Review history & prior studies
Study protocoled is not what was ordered
Remember to obtain a new order (and preauthorization) if you correct and inappropriate exam
order
Standard imaging protocol does not provide
what patient needs
Customize the existing imaging protocol to an
individual patient's need
Customizing
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Consider allergies (avoid contrast)
Consider claustrophobia (shorten imaging time)
Consider pregnancy
Consider kidney function, diabetes etc
Did prior study recommend a specific follow-up technique? (MRA, contrast, thin
cuts, different coverage of area)
Order
Protocol
What patient
needs
The goal is to determine what the patient needs and
make sure it conforms with the study request
and the selected imaging protocol.