Integrating CT contrast use policies into electronic medical record brings safety to the fore

Partners Healthcare System in Boston has integrated CT contrast media guidelines into its electronic medical record to encourage physicians to comply with the safety standards and to cut costs for the hospitals in its network.

"This is a perfect example of a way that the EMR can be used to really improve patient care, patient safety, and hospital efficiencies," said Partner's radiology administrative director Kathryn McCullough.

The new system is the result of a seven-year-long collaboration between McCullough, Dr. G. Scott Gazelle, director of the Institute of Technology Assessment at Massachusetts General Hospital, and Prerna Kahlon, director of quality measurement and improvement at Children's Hospital Boston. They joined forces in 2003 to assess contrast media administration guidelines at the system's six hospitals. They also collected data on the many screening procedures used to identify patients at risk for contrast reactions.

The investigators discovered wide variation in CT contrast policies and procedures across the system. Although five of the six hospitals used some form of screening to spot at-risk patients, methods varied from institution to institution. None of the hospitals consistently followed its own contrast media administration guidelines, and only three followed the American College of Radiology contrast reaction's classification system. In addition, none of the hospitals' radiology departments were able to record or retrieve CT contrast reaction information on the system's EMR.

The findings were published in the August Journal of the American College of Radiology (JACR 2009;6:562-566).

"Our team determined that we could improve patient safety by identifying best practices and standardizing our policies and procedures around CT contrast media administration," McCullough told Diagnostic Imaging.

The Partners CT Contrast Media Team developed a standard code for contrast media administration for all hospitals plus a patient questionnaire and adverse reaction form. They then designed a process to enable documenting and communicating this information through the EMR.

While improving patient safety, the investigators also found that the initiative has improved efficiency by providing valuable information to radiologists, technologists, and nurses well in advance of a patient's procedure. This helps identify patients with a history of prior contrast reactions and plan accordingly, McCullough said.

"This reduces the need for cancellations and delays, and consequently saves time and money," she said.

McCullough, Gazelle, and Kahlon will next try to make contrast reaction data stored in the system's EMR automatically available to referring physicians at the time they use Partner's computerized order entry system. The Contrast Media Team has already started incorporating data about contrast media reactions from other imaging modalities into the system, McCullough said.

"We are tracking MR contrast media reactions both in our data dashboard as well as electronically in the EMR," she said.