Implementation of an Institution-Wide Rules-Based Automated CT Protocoling System.

Background: Examination protocoling is a noninterpretive task that increases radiologists' workload and can cause workflow inefficiencies. Objective: To evaluate effects of an automated CT protocoling system on examination process times and protocol error rates. Methods: This retrospective study included 317,597 CT examinations (mean age, 61.8±18.1 years; male, 161,125; female, 156,447; unspecified sex, 25) from July 2020 to June 2022. A rules-based automated protocoling system was implemented institution-wide; the system evaluated all CT orders in the EHR and assigned a protocol or directed the order for manual radiologist protocoling. The study period comprised pilot (July 2020-December 2020), implementation (January 2021-December 2021), and postimplementation (January 2022-December 2022)phases. Proportions of automatically protocoled examinations were summarized. Process times were recorded. Protocol error rates were assessed by counts of quality improvement (QI) reports and examination recalls, and comparison with retrospectively assigned protocols in 450 randomly selected examinations. Results: Frequency of automatic protocoling was 19,366/70,780 (27.4%), 68,875/163,068 (42.2%), and 54,045/83,749 (64.5%) in pilot, implementation, and postimplementation phases (p<.001). Mean times from order entry to protocol assignment for automatically and manually protocoled examinations for emergency department examinations was 0.2±18.2 hours and 2.1±69.7 hours; inpatient examinations was 0.5±50.0 and 3.5±105.5 hours; and outpatient examinations was 361.7±1165.5 and 1.289.9±2050.9 hours (all p<.001). Mean times from order entry to examination completion for automatically and manually protocoled examinations for emergency department examinations was 2.6±38.6 hours and 4.2±73.0 hours; inpatient examinations was 6.3±74.6 and 8.7±109.3 hours; and outpatient examinations was 1367.2±1795.8 and 1471.8±2118.3 hours (all p<.001). In the three phases, there were 3, 19, and 25 QI reports, and 0, 1, and 3 recalls, for automatically protocoled examinations, versus 9, 19, and 5 QI reports, and 1, 7, and 0 recalls, for manually protocoled examinations. Retrospectively assigned protocols were concordant with 212/214 (99.0%) of automatically protocoled versus 233/236 (98.7%) of manually protocoled examinations. Conclusion: The automated protocoling system substantially reduced radiologists' protocoling workload while decreasing times from order entry to protocol and examination completion; protocol errors and recalls were infrequent. Clinical Impact: The system represents a solution for reducing radiologists' time spent performing noninterpretive tasks while improving care efficiency.