107 - EPIC Workflow Changes to Improve Interventional Radiology Consult Triage and Reduce Overnight Paging Volume

Purpose: While IR procedures for hospitalized patients have often been ordered directly by referrers, increasing patient and procedure complexity have driven a shift towards consultation whereby the IR service integrates the clinical question and history to determine an appropriate plan and/or procedure. Within Radiant (the default EPIC environment for Radiology) initial implementations typically enable direct ordering by referring clinicians. At our institution, we converted to a consult-driven workflow with an IR consult order that collects triage information, including order priority, to populate a worklist. Only consults with “STAT” priority generate a direct page to the on-call physician. This replaced a prior workflow wherein all procedure requests, regardless of priority, were accompanied by a page. In this study, we quantify the impact of our intervention, particularly with respect to after-hours requests.

Materials and Methods: Retrospective review identified 6,488 IR consult orders from 7/1/2024-6/30/2025. Pertinent patient and referral details were used to analyze rates of consult placement and cancellation according to priority and time. Data were analyzed using R; t-tests were used to compare continuous variables.

Results: Of 6,488 consults placed, 4,667 (71.9%) were completed while the remainder were cancelled prior to fulfillment, primarily due to either a change in clinical plan or a mistake preceding order modification. During this period 3,791 IR procedures were performed on hospitalized inpatients. Order priority prevented 1,452 requests from generating an unnecessary page after-hours (27.9 per week), representing 71.7% of after-hours orders. Routine requests occurred more frequently during business hours (1.08 vs. 0.138 consults/hr; p< 0.0001), whereas no significant difference was observed for STAT consults (0.083 vs. 0.073 consults/hr; p=0.14). A substantial number of consults (13%, n=613) reflected requests intended for a different procedural subspecialty, including within Radiology.

Conclusion: Among other important benefits, implementation of an IR consult-driven workflow significantly reduced after-hours pages to the on-call physician by routing non-STAT consults to a routine queue. The frequency of consults ordered with STAT priority did not vary significantly with time-of-day, suggesting appropriate use of the priority modifier. A substantial incidence of erroneous consults intended for other procedural subspecialties suggests that a unified imaging-guided procedure order may further improve IR triage and referrer experience.