Questions and Answers on "Change order" button for CT and MRI protocols

The change order button built into our EPIC protocol screens for CT and MRI utilizes our Clinical Scheduling Assistants (CSA) to make calls/emails on our behalf to edit orders that are deemed incorrect after radiologist review. We are still seeing some confusion and misuse of the feature so I have put together some common errors for review below.

CAN WE USE IT FOR BOTH IN-PATIENTS AND OUT-PATIENTS?

Yes- But you can NOT use the change order button to request changes for exams ordered STAT or LIFE THREATENING. This requires a phone call from radologist as CSA staff can't get to these studies quick enough in a reliable fashion.

CAN WE USE THIS BUTTON TO REQUEST CHANGES ANYTIME OF DAY?

The CSA staff are only present to work on our behalf Monday to Friday during business hours 8am-430pm. You CANNOT use the change order button after 430pm or on weekends for any in-patient case. You can use it for routine out-patient scans ordered over weekend or protocoled over weekend that are not being scanned that weekend. CSA staff will address those on Monday when they return.

CAN I JUST CHANGE THE ORDER FOR IN-PATIENT SCANS WHEN PROTOCOLING WITHOUT USING THE CHANGE ORDER BUTTON OR TALKING TO THE CLINICAL TEAM?

No. You can't change in-patient orders without having a discussion with clinical team. The protocol by the radiologist has to actually match the order. If clinical team can't edit the order in EPIC, please write who OK'ed the change from the clinical team in your protocol and the techs can change the order on their end when those details are provided. This is to ensure that radiology and clinical team are both in agreement on study to perform. In these cases you DO NOT need to click the change order button as CSA staff will not be involved.

The CT techs should not be following our protocol if the ordered study does not match. If this happens, they will be instructed to call the reading and get the discrepancy fixed. Attending radiologist can still opt to disregard the order and scan differently if deemed medically necessary to do so (but this needs documentation in the report so our billing staff will understand the discrepancy).

SO WHEN CAN I USE THE CHANGE ORDER BUTTON ON AN IN-PATIENT?

  1. If the scan is ordered with routine or urgent priority
  2. It is between 8am and 430pm Monday to Friday
  3. You would like the CSA to contact the in-patient medical team on your behalf

If all these conditions are met, click the change order button and write details out in comments on why you want order changed. This applies to in-patients hospitalized at both York Street and SRC campuses.

This can be a great time saving feature for us radiologists if you don’t have time to track down a clinical team member to verbally discuss the case. If the clinical team member wants to discuss case after being contacted by a CSA, the CSA will facilitate transfer of call to appropriate reading room/radiologist.

CAN I USE THE CHANGE ORDER BUTTON FOR SCANS ORDERED BY BRIDGEPORT PROVIDERS OR SCANS BOOKED FOR OUR BHOR PARK AVE. FACILITY?

Unfortunately, no. The BHOR/Bridgeport facilities do not have CSA staff and our YNHH staff do not handle those cases. Hence nobody is there to actually make calls on our behalf for incorrect orders. For now, this still requires a phone call from a radiologist to ordering provider office to have order fixed. We are working on getting BHOR integrated with the change order process, but a system/staffing is not in place yet.

CAN I USE THIS CHANGE ORDER BUTTON FOR ED PATIENTS?

No, ED patients still require direct call to the ED provider.