Utilization Review of Simultaneously Ordered Multiple Radiologic Tests for the Same Symptom

Abstract

The purpose of this study was to analyze the utiliza tion of multiple radiologic procedures ordered simulta neously for the same clinical problem. The method was a retrospective study of patients referred to an urban community hospital who had multiple radiologic tests ordered simultaneously before the referring physician reviewed any of the results. Utilization Findings Codes, beta versions II and III, of the American College of Radiology were applied. In- and outpatient charts were reviewed for initial indication, subsequent diagnosis, and treatment. Ninety-three patients had 214 radiologic ex aminations (2.3 per patient). Of the 214 total, 129 (60%) were retrospectively coded as inappropriate (beta II ver sion). For 98 reports, the initial interpreting radiolo gist's coded 16% as inappropriate versus 55% when retrospectively coded by the authors (P < 0.0001). After applying the beta III version, 18% were coded as posi tive (and related to symptoms), 79% negative, and 3% equivocal. There were 161 (74%) examinations ordered by primary care physicians and 53 tests ordered by spe cialists. Using the beta III version, the negative rate for primary care physicians was 81 and 75% for specialists (P = 0.447). It was concluded that ordering multiple ra diologic tests simultaneously on the same patient resulted in a high number of inappropriate procedures and negative results.