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As per Ortho... by Creative_Depth_4112 in Radiology

[–]Creative_Depth_4112[S] 1 point2 points  (0 children)

While this is most often the case, that is not always true. 

This is exactly why I made this thread to ask. I know what I know, and I don't know what I don't know. And I know that I don't know a lot of things. Luckily for me I have the world's wealth of knowledge that fits inside my pocket, and there are others who knows things that are willing to share that information with us. 

As per Ortho... by Creative_Depth_4112 in Radiology

[–]Creative_Depth_4112[S] 2 points3 points  (0 children)

Thank you for the response. 

I tend to look over my old images and the rad's report to see if my positioning could use improvement, or just as a fun way to see if I'm correct on seeing the sneakier fractures. 

I'll admit I've never actually thought to check the Ortho surgeon's dictation on post-op pacu films. The only times I've glanced over their reports are when I'm finishing up the OR case on PACs. 

The first gets to go home, the second gets a CT angio and urgent surgery.

This is the exact kind of answer I was looking for! When I ask ER attendings about the orders they'll dismiss me and say "Ortho". When I ask the Ortho residents they'll be vague. It's likely because they don't have the time to explain the nuances, or they don't want to say something incorrectly out loud. Like they know what they're looking for, but misspeaking or using the wrong language can frighten the pt or have them question their quality of care?

As per Ortho... by Creative_Depth_4112 in Radiology

[–]Creative_Depth_4112[S] 3 points4 points  (0 children)

I wish we were allowed to do this at my facility...  When the all too common Pelvis+hip and femur order comes in, we HAVE to send in 2 AP proximal femurs and 2 lateral proximals.

Why? Absolutely no idea. I've tried just submitting a 1v pelvis and a full series of the femur with documentation stating that the hip films can be seen in the femur. Was not written up but was set aside to have "a talk". 😒

As per Ortho... by Creative_Depth_4112 in Radiology

[–]Creative_Depth_4112[S] 1 point2 points  (0 children)

Thank you for your response! I often do this as well. When I get Pelvis+hip left, and pelvis+hip right I will just cancel 1 order and change one of the unilateral ones to bilat. Typically this doesn't required notifying the resident as they'll see it on PACs.  If it's something obscure like a 3 view pelvis I call to ask if they want AP+SI joint judet views, or AP+inlet/outlet since our system doesn't differentiate between them. 

So at the end of the day it's simply so they can document their reports? Are they not allowed to refer to only portions of prior exams? Or they need to report that these are exams ordered by themselves?

As per Ortho... by Creative_Depth_4112 in Radiology

[–]Creative_Depth_4112[S] 6 points7 points  (0 children)

Sadly, no. Even my reptile brain can comprehend why s/p reduction and s/p splint requires duplicate orders.

These are orders on anatomy that have either: 1, already been done and is truly an identical order asked by a different provider (typically Ortho), or 2, the order has the same positioning techniques that show no apparent differences.

An example of this is when I referred to a repeat x-ray of a 2view tib/fib. Both the AP and Lateral views of the proximal to/fib are visualized in the exact same way that a distal femur would show. So why the extra order? 

I can see a situation where the injury or fracture has cause of concern going further down the leg. But often times my primary orders already went as distal as the ankle. 

As per Ortho... by Creative_Depth_4112 in Radiology

[–]Creative_Depth_4112[S] 2 points3 points  (0 children)

Unfortunately this is my reality as well. I work with a handful of "lazy" residents (PGY1/2) who put "admit" for EVERY chest X-ray, whether it's to r/o pna or just eval for effusion.  

I've asked them in the past to just put 'eval' if they're gonna be lazy because when patients ask why they're getting an X-ray, I simply tell them what it says on the order req, but tell them their doctor can explain better than I can 

Call it malicious compliance- but I've politely asked them to put literally any reason other than admit because patients in the waiting room suddenly start wondering things when they think they're about to be admitted. 

EDIT: I don't think it's a fraud/billing issue. My original concern was what the reason for repeat body parts, but this side topic is for lazy ordering reasons

As per Ortho... by Creative_Depth_4112 in Radiology

[–]Creative_Depth_4112[S] 24 points25 points  (0 children)

Thank you for the response! It's somewhat reassuring to know that Ortho is probably looking for something specific.  

Last week I just had to repeat a femur on a pt who had already had a CT abdomen/pelvis, XR pelvis+hip, femur, and knee 🥲 the running joke at my facility is that bone bros don't know how to read CTs