S02_Attachment_15_Procedures_for_Requesting_Radiographic__Examinations.doc

Attachment 15 – 36C24919R0003

MEDICAL CENTER POLICY MEMORANDUMS

NUMBER/TITLE OF POLICY: 114-08 PROCEDURES FOR REQUESTING RADIOLOGY AND NUCLEAR MEDICINE EXAMINATIONS

CHANGES FROM PREVIOUS MCM:

Page 1, paragraph 3. Interventional Radiology examinations are scheduled by the assigned Radiology nurse.

Page 2, (b) Urgent procedures will be done during regular business hours ahead of routine examinations.

Page 2, c. Interventional Radiologic Procedures (added e-consults) Page 3, paragraph 1. Urgent examinations will be done during regular business hours before routine examinations.

Page 3, d. CT Procedures section updated since contrast is now addressed by Contrast Policy.

Page 3, d. CT Procedures section: correction non-routine CT requests are reviewed by a radiologist for protocol. STAT procedures will be done within ONE hour after the patient arrives in CT.

Page 3, e. MRI Procedures added The MRI initial screening template must be completed by the ordering provider.

Page 4, (5) STAT MRI restricted to Brain and Spine exams.

Page 4. After-hours ultrasound POC clarified.

POINT OF CONTACT FOR FURTHER INFORMATION:

Reginald Penny, Radiology Administrative Officer, EXT- 5382

POLICY MEMORANDUM

VA Medical Center

1030 Jefferson Avenue

Memphis, TN 38104

Number:

114-08

Dated:

December 15, 2017

Expires: December 31, 2022

Title:

PROCEDURES FOR REQUESTING RADIOLOGY AND NUCLEAR MEDICINE EXAMINATIONS

1.

PURPOSE: To establish guidelines for requesting radiology and nuclear medicine examinations.

2.

POLICY: All appropriately ordered examinations will be performed and interpreted in a timely and accurate manner. Orders will only be placed in CPRS with use of appropriate templates. Any imaging order placed through VistA will be cancelled by radiology or nuclear medicine staff and a view alert sent to the ordering provider.

3. RESPONSIBILITY: Providers are responsible for ordering appropriate procedures. Radiology/Nuclear Medicine personnel are responsible for performing and interpreting procedures in a timely and accurate manner. The Business Office is responsible for scheduling radiology/nuclear medicine studies. Interventional Radiology examinations are scheduled by the assigned Radiology nurse.

4.

PROCEDURE:

a. Routine Diagnostic Radiographic Procedures: (Standard x-ray procedures not requiring contrast or presence of a physician).

(1) Requests for routine diagnostic radiographic procedures on outpatients will be generated in the computer using the Computerized Patient Record System (CPRS) prior to the patient being directed to the Radiology Service. A separate request is required for each procedure to be performed and must include a pertinent clinical history relative to each procedure.

(2) Requests for routine diagnostic radiographic procedures on inpatients will be generated in the computer using the Computerized Patient Record System (CPRS). A separate request is required for each procedure to be performed and must include a pertinent clinical history relative to each procedure. All requests for procedures on inpatients will be reviewed and the appropriate ward contacted as to when to send inpatients to radiology.

(3) All routine diagnostic radiographic procedures are prioritized in the following order:

(a) “Stat” procedures will be performed within 60 minutes, 24 hours per day, seven (7) days per week. Since “Stat” procedures may disrupt the normal flow, they should not be requested unless the procedure is needed for immediate patient care.

(b) “Urgent”/”ASAP” procedures will be performed during regular business hours ahead of routine examinations.

(c) “Routine” procedures will be performed to allow for minimal patient waiting and smooth workflow. Routine procedures will be performed within 24 hours.

(d) “Routine” procedures will be performed seven (7) days per week until 10:00 p.m. as the “Stat” and “Urgent” workload permits.

(e) “Bedside” or “Portable” procedures will be performed ONLY on those patients that cannot be transported to the Radiology Service, since the quality of the bedside procedure is generally inferior.

b. Scheduled Diagnostic Radiographic Procedures:(Procedures requiring administration of contrast and/or use of complex imaging equipment).

(1) Requests for scheduled diagnostic radiographic procedures on outpatients will be generated in the computer using the Computerized Patient Record System (CPRS). A separate request is required for each procedure to be performed and must include a pertinent clinical history relative to each procedure. Personnel from the ordering clinic must then schedule the patient in the appropriate radiology clinic using the clinic scheduling options in the VistA computer system. Personnel from the ordering clinic will provide the preparation instruction and the necessary prep materials before the patient departs their clinic. Those patients not adequately prepped are rescheduled and re-prepped. For procedures that are stat or urgent, the ordering provider should call the radiology department and discuss the urgency with the radiologist that will be performing the procedure.

(2) Requests for scheduled diagnostic radiographic procedures on inpatients will be generated in the computer using the Computerized Patient Record System (CPRS). A separate request is required for each procedure to be performed and must include a pertinent clinical history relative to each procedure. Business Office personnel will schedule all inpatient procedures requiring preps and notify the appropriate ward. For procedures that are stat or urgent/ASAP, the ordering provider should call the radiology department and discuss the urgency with the technologist or radiologist that will be performing the procedure.

c. Interventional Radiographic Procedures:

(1) Requests for Interventional Radiographic procedures will be generated in the computer using e-consults through the Computerized Patient Record System (CPRS). Requesting providers must contact the Interventional Section prior to ordering STAT procedures. STAT procedures may only be approved by the Interventional Radiologist assigned to cover that day. It will be the requesting provider's responsibility to schedule patient admissions. The Interventional Radiologist approves all requests and may contact the ordering provider to clarify requests. The Radiology nurse assigned to Interventional Radiology will schedule all inpatient examinations and notify the appropriate ward of the scheduled appointment date/time.

(2) For “Stat” Interventional procedures during other than normal duty hours, the Interventional Radiologist will be contacted. The Interventional Radiologist will contact the necessary on-call personnel. Urgent/ASAP examinations will be done during regular business hours before routine examinations.

d. CT Procedures:

(1) Requests for Computerized Tomography procedures will be generated in the computer using the Computerized Patient Record System (CPRS). A separate request is required for each procedure to be performed and must include a pertinent clinical history relative to that procedure. All non-routine CT requests are reviewed by a radiologist who determines the examination protocol to be used. After the examination protocol has been determined, CT personnel will notify the patient or the ward (if the patient is an inpatient), of the scheduled appointment date/ time and necessary prep, as applicable. For procedures that are stat or urgent/ASAP, the ordering provider must call the CT Section and discuss the urgency with the assigned radiologist. STAT procedures will be done within ONE hour after the patient arrives in CT. Exams ordered as URGENT/ASAP will be done during regular business hours ahead of routine examinations.

e. MRI Procedures:

(1) Requests for Magnetic Resonance Imaging procedures will be generated in the computer using the Computerized Patient Record System (CPRS). A separate request is required for each procedure to be performed and must include a pertinent clinical history relative to that procedure. Providers must use the appropriate MRI order template or Utilization Management process. All routine MRI requests are reviewed by a radiologist who determines the examination protocol to be used. These radiologists may contact the ordering provider to clarify requests. Requesting providers are encouraged to consult with the radiologists assigned to MRI prior to ordering MRI procedures to determine the most appropriate diagnostic approach. After the examination protocol has been determined MRI or Business Office personnel notify the patient or the ward if the patient is an inpatient, of the scheduled appointment date/time and necessary prep as applicable. For procedures that are stat or urgent, the ordering provider must call the MRI Section and discuss the urgency with the assigned technologist. The MRI initial screening template must be completed by the ordering provider.

(2) Major contraindications for MRI:

(a) Cochlear, otologic, or other ear implant;

(b) Intracranial Aneurysm Clips;

(c) Neuro Stimulators;

(d) Pacemaker/Pacing Wires;

(3) Information on types of implants, clips and devices compatible/contraindicated can be obtained from the MRI Section.

(4) Prior to the MRI procedure, all patients must be screened by the requesting physician regarding the contraindications for MRI procedures. Appropriate screening x-rays may be ordered by MRI staff.

(5) For “STAT MRI procedures after hours the requesting provider will contact the MAA in the ED. The MAA will contact on-call personnel. STAT requests for MRI will only be honored for examinations of the brain or the spine.

(6) On-call personnel will not be called back for non-brain or spine MRI examinations unless approved by the COS or his/her designee. STAT requests for non-brain/spine exams will be treated as urgent and placed ahead of routine examinations during regular business hours. Should a provider determine that a STAT exam of a non-brain/spine body region is indicated after-hours the provider is required to contact their Service Chief. If the Service Chief agrees that there is medical justification to obtain the exam on a “STAT” basis he/she is required to contact the COS/designee. If the COS/designee concurs he/she will contact the appropriate radiology manager to arrange for the exam to be done STAT.

f.

Nuclear Medicine Procedures:

(1) Requests for Nuclear Medicine procedures will be generated in the computer using the Computerized Patient Record System (CPRS). A separate request is required for each procedure to be performed and must include a pertinent clinical history relative to that procedure. All Nuclear Medicine routine requests are reviewed by a radiologist who determines the examination protocol to be used. After the examination protocol has been determined, Business Office personnel will schedule all Nuclear Medicine examinations and notify the patient or the ward (if the patient is an inpatient), of the scheduled appointment date/time and necessary prep as applicable. For procedures that are stat, the ordering provider must call the Nuclear Medicine Department and discuss the urgency with the assigned technologist.

(2) For “Stat” Nuclear Medicine procedures after hours the requesting provider will contact the MAA in the ED. The MAA will contact on-call personnel. Urgent and ASAP exams will be performed during regular business hours ahead of routine examinations.

g.

Ultrasound Procedures:

(1) Requests for Ultrasound procedures will be generated in the computer using the Computerized Patient Record System (CPRS). A separate request is required for each procedure to be performed and must include a pertinent clinical history relative to that procedure. Business Office personnel will schedule all ultrasound examinations and notify the patient or the ward (if the patient is an inpatient), of the scheduled appointment date/time and necessary prep as applicable. For procedures that are stat, the ordering provider should call the Ultrasound Section and discuss the urgency with the assigned radiologist.

(2) Ultrasound technologists are not routinely provided for after hours call back requests. The radiology resident on-call may be contacted for consultation for alternative imaging procedures. The facility will provide service at community hospitals to assist with after-hours care. Call the MAA in the ED for instructions on arranging this service after-hours.

h. Denial of Radiology Requested Procedures (any type)

(1) Denial or refusal to perform any type of requested procedures (during routine or off hours) must be authorized by a staff level radiologist.

i. Pregnancy

(1) The ordering provider will inform radiology in the order if the patient is pregnant.

5.

REPORTING REQUIREMENTS: None.

6.

RESPONSIBLE OFFICE: Radiology Service (114) 7.

REFERENCE: None.

8. RESCISSION: Medical Center Policy Memorandum 114-08, dated August 21, 2015 Medical Staff Concurrence:

Date: December 15, 2017 /s/

THOMAS C. FERGUSON, M.D.

Chief of Staff

/s/

DAVID J. DUNNING, MPA

Medical Center Director

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