Optimizing Imaging Clinical Decision Support: Perspectives of Pediatric Emergency Department Physicians

Purpose: The aim of this study was to solicit perspectives of pediatric emergency department physicians (PEDPs) to determine how software-based clinical decision support mechanisms (CDSMs) may integrate with existing imaging clinical decision support (ICDS) to optimize imaging utilization at the authors’ institution. Methods: Through qualitative interviews, the authors explored how PEDPs define ICDS, how they seek and obtain radiologist consultation, and how the rollout of CDSMs at the institution may potentially affect clinical practice. Codes were developed and explicitly defined through literature review and analysis of a subset of interviews. Coding results informed thematic categories used to develop an explanatory model. Results: Analysis revealed three major thematic categories: (1) common influences on the decision process, (2) radiology consultation experience, and (3) PEDPs’ perspectives on CDSMs. PEDPs described radiologist consultation as a valuable component of ICDS but reported difficulty in coordinating imaging strategies with radiologists and other subspecialists. PEDPs described the exchange of ideas as especially worthwhile for scenarios that do not fit neatly into clinical pathways. Barriers to radiologist consultation include time, access to radiologists, and not wanting to disrupt radiologists’ workflow. PEDPs expressed optimism that CDSMs may improve their workflow and facilitate effective interaction with radiologists. Conclusions: PEDPs suggested that radiologist consultation will continue to be a valuable component of ICDS after the implementation of CDSMs by providing discussion-driven guidance to complement CDSM recommendations. The results also indicate that radiologists may consider strategies to facilitate effective interaction with PEDPs and reconcile conflicts of CDSMs with clinical practice.