Purpose or Case Report: To explore the imaging clinical decision support (ICDS) needs of pediatric emergency department physicians (PEDP’s) prior to the implementation of imaging clinical decision support software (ICDSS).
Methods & Materials: Following institutional review board approval, through semi-structured interviews, researchers explored perspectives of 30 PEDP’s on how they seek and obtain imaging consultation and the potential impact of ICDSS on practice. Open-ended questions were designed to elicit a range of responses rather than quantifiable data. The team employed a directed content analysis approach and codes were developed and explicitly defined through team evaluation. Coding and analysis was facilitated by NVivo 12 Software. Two research assistants independently coded all transcripts and discrepancies were addressed through consensus (mean k = 0.99). Codes were arranged into thematic categories to inform an explanatory model that illustrates the PEDP’s priorities and needs related to the imaging decision process.
Results: Data analysis revealed three thematic categories: (1) Common Influences on the Decision Process (these include patient factors, PEDP’s experience, the specialist perspective, and logistics), (2) Radiology Consultation Experience, (3) PEDP Perspectives on ICDSS which includes perspectives on how implementation of an ICDS system at our institution may impact practice. PEDP’s described consultation as a valuable component of ICDS but reported difficulty in coordinating an imaging strategy with radiologists and other physician consultants. PEDP’s described the exchange of ideas as especially worthwhile for clinical scenarios that do not fit neatly into ICDS pathways. Significant barriers to radiologist consultation included: time, access to radiology attendings, limited confidence in trainees, and not wanting to disrupt radiologist workflow. PEDP’s expressed a belief that ICDSS could potentially improve their workflow and augment effective interaction with the radiology department.
Conclusions: PEDP’s predict that radiologist consultation will continue to be an essential component of ICDS following the implementation of ICDSS. These results present an opportunity for radiologists to improve in-person radiologist consultation in clinical and didactic settings. Additionally, these findings will inform the development and implementation of an ICDSS system that meets the needs of the PEDP's and ultimately improves patient outcomes.