Luxenburg Osnat, Vaknin Sharona, Wilf-Miron Rachel, Saban Mor
Medical Technology, Health Information and Research Directorate, Ministry of Health, Jerusalem, Israel.
The Gertner Institute for Health Policy and Epidemiology, Ramat-Gan, Israel.
J Imaging Inform Med. 2025 Feb;38(1):357-367. doi: 10.1007/s10278-024-01197-5. Epub 2024 Jul 19.
Radiology referral quality impacts patient care, yet factors influencing quality are poorly understood. This study assessed the quality of computed tomography (CT) referrals, identified associated characteristics, and evaluated the ESR-iGuide clinical decision support tool's ability to optimize referrals. A retrospective review analyzed 300 consecutive CT referrals from an acute care hospital. Referral quality was evaluated on a 5-point scale by three expert reviewers (inter-rater reliability κ = 0.763-0.97). The ESR-iGuide tool provided appropriateness scores and estimated radiation exposure levels for the actual referred exams and recommended exams. Scores were compared between actual and recommended exams. Associations between ESR-iGuide scores and referral characteristics, including the specialty of the ordering physician (surgical vs. non-surgical), were explored. Of the referrals, 67.1% were rated as appropriate. The most common exams were head and abdomen/pelvis CTs. The ESR-iGuide deemed 70% of the actual referrals "usually appropriate" and found that the recommended exams had lower estimated radiation exposure compared to the actual exams. Logistic regression analysis showed that non-surgical physicians were more likely to order inappropriate exams compared to surgical physicians. Over one-third of the referrals showed suboptimal quality in the unstructured system. The ESR-iGuide clinical decision support tool identified opportunities to optimize appropriateness and reduce radiation exposure. Implementation of such a tool warrants consideration to improve communication and maximize patient care quality.
放射学转诊质量影响患者护理，但影响质量的因素却知之甚少。本研究评估了计算机断层扫描（CT）转诊的质量，确定了相关特征，并评估了ESR-iGuide临床决策支持工具优化转诊的能力。一项回顾性研究分析了一家急症医院连续300例CT转诊病例。由三位专家评审员以5分制对转诊质量进行评估（评分者间信度κ = 0.763 - 0.97）。ESR-iGuide工具为实际转诊的检查和推荐的检查提供了适宜性评分和估计的辐射暴露水平。比较了实际检查和推荐检查的评分。探讨了ESR-iGuide评分与转诊特征之间的关联，包括开单医生的专业（外科与非外科）。在这些转诊病例中，67.1%被评为适宜。最常见的检查是头部和腹部/盆腔CT。ESR-iGuide认为70%的实际转诊“通常适宜”，并发现推荐的检查相比实际检查估计的辐射暴露更低。逻辑回归分析表明，与外科医生相比，非外科医生开出不适当检查的可能性更大。在非结构化系统中，超过三分之一的转诊显示质量欠佳。ESR-iGuide临床决策支持工具发现了优化适宜性和减少辐射暴露的机会。考虑实施这样一种工具以改善沟通并最大限度提高患者护理质量。
