Reducing inappropriate diagnostic practice through education and decision support

Abstract

Objective: To quantify non-compliance of diagnostic practice with recommendations in Diagnostic Imaging Pathways and the impact of interventions to reduce non-compliance. Design: Retrospective audits, followed by intervention and re-audits. Setting: Emergency department (ED) of Royal Perth Hospital. Participants. Six hundred and thirty-eight patients (first audit) and 423 patients (second audit) presenting to the ED with one of the four conditions: suspected pulmonary embolism, ankle injury, suspected renal colic or non-traumatic acute abdominal pain. Interventions: Education of clinicians on Diagnostic Imaging Pathways recommendations for the four conditions. Decision support through the introduction of request forms, which required 'proof ' of adherence to diagnostic pathways. Main outcome measures: Percentage of patients with a deviation from recommended diagnostic practice. Results: Overall, 56% of patients had evidence of inappropriate diagnostic practice prior to interventions, with a reduction of 16% following the interventions. Conclusion: The reduction was significant but inappropriate practice was not eliminated. For as long as decision-support systems are 'stand-alone' applications, achieving full compliance is dependent on continuous and expensive processes of education and enforcement. A better understanding of why clinicians fail to follow recommended practice is required, and decision support must be better embedded into clinical workflow. © The Author 2010. Published by Oxford University Press in association with the International Society for Quality in Health Care; all rights reserved.