Electronic Health Record Order Entry-Based Interventions in Response to a Global Iodinated Contrast Media Shortage: Impact on Contrast-Enhanced CT Utilization

• Published in: American journal of roentgenology (1976) Vol. 220; no. 1; pp. 134 - 140
• Main Authors: Glazer, Daniel I, Lucier, David J, Sisodia, Rachel C, Sharma, Amita, Gervais, Debra A, Park, Lee, Abbasi, Nooshin, Hubbell, Harrison T, Kapoor, Neena, Flores, Efren J, Saini, Sanjay, Khorasani, Ramin
• Format: Journal Article
• Language: English
• Published: United States 01.01.2023
• Subjects: Contrast Media; Electronic Health Records; Humans; Radiology; Retrospective Studies; Tomography, X-Ray Computed; CT; iodinated contrast; iodinated contrast shortage; supply chain
• ISSN: 0361-803X; 1546-3141; 1546-3141
• DOI: 10.2214/AJR.22.28143

Radiology informatics systems and clinical decision support tools in the electronic health record (EHR) can be leveraged to help impact ordering patterns in response to the ongoing global iodinated contrast media shortage. The purpose of our study was to assess the impact of EHR order entry-based interventions, implemented as part of a health system's response to the global contrast media shortage, on contrast-enhanced CT utilization. This retrospective study included 79,259 patients who underwent CT at a large multisite health system between April 1, 2022, and July 3, 2022. Two EHR-based interventions were implemented as part of the health system's response to the global contrast media shortage. A first EHR-based intervention on May 10, 2022, entailed creating an alert that appeared in a sidebar after any contrast-enhanced body CT orders, indicating the present shortage and recommending alternate imaging modalities. A second EHR-based intervention on May 16, 2022, required referrers to enter detailed clinical information for all contrast-enhanced body CT orders, which radiologists used when protocoling examinations. Data regarding CT orders and examinations performed were extracted from the electronic data warehouse. During the preintervention, first postintervention, and second postintervention periods, the mean number of patients who underwent contrast-enhanced CT per weekday was 726, 689, and 639, respectively ( for preintervention vs second postintervention periods, < .001). During the three periods, the mean number of patients who underwent CT per weekday was 1350, 1323, and 1314 ( < .001). During the three periods, the mean number of patients who underwent contrast-enhanced body CT per weekday was 561, 532, and 492 ( < .001). During the three periods, the mean number of orders for CT with IV contrast media per weekday was 154, 143, and 131 ( < .001). During the three periods, the mean number of orders for CT without IV contrast media per weekday was 196, 202, and 221 ( < .001). EHR order entry-based interventions implemented in response to the global contrast media shortage significantly reduced contrast-enhanced CT utilization in a large health system. The findings indicate the ability to rapidly achieve changes in ordering clinician behavior and subsequent clinical practice using systemwide EHR changes.