Structured Order for CT Trauma Improves Communication

December 16, 2014

Using a structured order entry for trauma CTs results in better communication, recording, and billing.

A structured physician order entry for trauma CT significantly improves clinical history communication to radiologists, according to a study published in the American Journal of Roentgenology.

Researchers from Brigham and Women's Hospital and Harvard Medical School in Boston, MA sought to measure the effects of a structured physician order entry system for trauma CT on the communication of clinical information and on coding practices and reimbursement efficiency.

Of 2,734 distinct examinations, 457 “pan-scans” – head through pelvis trauma CTs – were included in the study that was conducted between April 1, 2011 and January 14, 2013. A total of 277 patients underwent 1,642 examinations before implementation of the structured trauma CT order entry, and 180 patients underwent 1,092 examinations after implementation.

Factors that were compared before and after implementation:

• Communication of clinical signs and symptoms and mechanism of injury

• Primary International Classification of Diseases, 9th revision

• Clinical Modification (ICD-9-CM) code category

• Success of reimbursement

• Time required for successful reimbursement for the examination

The results showed an absolute increase in primary outcomes:

	Before intervention	After intervention	Absolute increase
Requisitions containing clinical signs or symptoms	0.4%	63%	62%
Requisitions providing mechanism of injury	0.4%	99%	99%
Primary ICD-9-CM codes representing clinical signs or symptoms	2.9%	21.8%	19%
Reimbursement success for examinations submitted to insurance carriers	83.0%	89.7%	7%

For reimbursed studies, mean billing cycle time decreased from 68.4 days to 53.7 days, for a 14.7-day reduction.

“Despite the limitations, the results of our study support the notion that structured order entry can be adopted effectively in the emergency department for trauma patients and can successfully motivate referring physicians to provide more clinical information when they order trauma CT,” the researchers concluded.