Abuse of STAT

[ENT Doc]

If there’s something that urgent in my clinic they’re going to the ER. If that urgent in the hospital I call to see when they can be added on and explain, likely need the OR immediately after depending on the results. I don’t understand how someone justifies STAT as a random outpatient work up.

Military experience at my first command was more extreme than Anne’s VA experience. You had to call Radiology for ANYTHING you ordered in house. You would need to put a changing daily “code” in the order upon approval so they knew you spoke to someone. Sometimes they would flat out refuse to do what you wanted and suggested something else, which was awesome as an intern when your O-6 attending was telling you to order something and expected it would get done.

[VentAlarm]

I ordered a stat lab the other day for preop for my patient. Surgery in two hours. Lab draws it. Two hours later no results. Call the lab. They say that this stat lab, can't be ordered stat, is sent out, and will be back in 48 hours.

I'm like I literally ordered it stat in the emr. Lab says that, ya, u can "order it stat in the emr", but we can't process it stat.

Wtf.

Anyways, sx cancelled.

We also have stat and asap. I usually order asap when I want something like an MRI on weekends or something I need within 24 hours. Not sure what exactly asap means. Stat to me means within the next two hours.

What surgery are you not performing based on a lab that’s a send out?

[VentAlarm]

I rarely use STAT. Only when I need to rule out something more urgent that may involve additional work-up/hospitalizations (i.e. r/o DVT, diverticulitis). Typically I'm only ordering STAT to try to keep them out of the ER and manage outpatient, if possible. Most of my exams don't require STAT orders, and the radiologist around here typically get me results within 24 hours, so there isn't really a need for that.

Outpatient primary care.

Neither DVT nor diverticulitis seem that emergent….


As an aside, the real stat imaging is a call to the tech saying “I need this now, I’m putting in the order. Please page the radiologist as soon as it’s done.”

[MPMD]

I think I remember reading about one of the major training hospitals on the East Coast having this problem years ago. Something like 70% of all imaging studies in the hospital were ordered stat, while a review found that the number per day that were clinically indicated as stat was in the single digits. They instituted a new rule that the ordering physician (usually a resident) had to accompany the patient to radiology for any stat orders, which promptly fixed the problem.

As a good faith gesture to our radiologists and techs, I always do accompany any patients on whom I've ordered a stat study to radiology to interpret the study in real time (or at least ask the tech to page me when the patient is on the table so I can come down and review it in real time).

sounds like a solution created by people who have never had multiple sick pts to handle at once time.

[Panscan]

sounds like a solution created by people who have never had multiple sick pts to handle at once time.

Just depends on your outlook of what stat means. In a perfect world , a routine Ed study would be looked at as relatively high acuity like do it in the next hour if possible. This is your standard PE, diverticulitis , appy etc. Then like critical ones where you are convinced patient is dying and needs test to know why or to confirm suspicion , would be like a “ drop all studies and do this one.” Those would be the stats in an ideal world, like where I draft what I’m currently doing bc I know yours is more important. Ruptured AAA, crisis stroke etc

[Panscan]

The greater underlying problem is the lack of true stratification like the 18 yr old with a headache that gets called a crisis stroke alert has theoretically the same priority as the 70 yr old who has a clear clinical MCA deficit. You can call it whatever you want from stat to routine to whatever but we just need ways to truly stratify what is important and what is less important and that is being lost by this constant push for quicker TAT and doing everything right now regardless of acuity

[Random1]

I don’t think the problem , at least on my end is a stat test. The problem is that non stat tests are not completed in a timely manner in order to make a proper diagnosis and to appease patient expectations. Patients live in an instant world and expect this with their medical care especially tests. I have had many patients call the office when they leave to scan to ask what the results are.

[NumberWhizMD]

Neither DVT nor diverticulitis seem that emergent….


As an aside, the real stat imaging is a call to the tech saying “I need this now, I’m putting in the order. Please page the radiologist as soon as it’s done.”

Well, I typically call the imaging center directly, explain the need for the image and what I'm trying to rule out and why it's urgent. I am working with an outpatient-only radiology center and only order STAT imaging orders on things that do require less than 24 hour turnaround. I guess I'd be curious to know what you would consider STAT in an outpatient setting. My onus for ordering the imaging in the first place is trying to keep patients out of the ED (currently in a state with high COVID transmission) and manage their conditions as outpatient with close follow/up. If I think there is something more urgent than that, I typically send to ED directly. But in an effort to relieve some of the burden on our ED, our radiology center has never had any issues with this (and we meet with them regularly to review).

[NaOH]

A certain provider in our ED enters every single med order as a STAT. Every one.

Like, I know this isn't actually STAT and you are just trying to tell me that you need this order verified/dispensed now.

It's a one-time order from the ED. I think the 'now' part is generally understood.

[CordMcNally]

A certain provider in our ED enters every single med order as a STAT. Every one.

Like, I know this isn't actually STAT and you are just trying to tell me that you need this order verified/dispensed now.

It's a one-time order from the ED. I think the 'now' part is generally understood.

What’s the difference between ‘Now’ and ‘STAT’? I honestly thought pretty much every ED order is defaulted as Now or STAT.

[bean1970]

I’m in radiology and we constantly get STAT request for just about any body parts. When you read the history most are bogus. They just put STAT to get it in before they go home or before the weekend or before they go on a trip.

Everyone thinks their patient need STAT scans. And there is no real threshold to make and order a STAT scan of any body part.

So, what do you think about charging more for STAT scans? It diverts techs and radiologist away to have to complete these ‘non STAT’ STATs studies.

Right now the pay is the same for STATs or non STATs. But if STAT exams were charged more, maybe doctors, PAs, NPs (and even patients) might think a little more about ordering STATs.

Charging more affects the patients and puts more money in the hands of the insurance carriers. if anything, it would be personally charging the physician to get the point across lol.

We have same issue in pathology. Totally abused. Especially if you are in a hospital, you should track this as part of your Quality Assurance. What is being ordered stat? (imaging types), where are stats being ordered? (blanket hospital areas like ED/ICU vs the outpatient GI clinic), who is ordering stats (look at % by physician. is anyone ordering 100% stats who is not in a blanket area?) Another marker used to be to look at call to patient (is it STAT if the physician calls the patient a week later???), but this is becoming obsolete with immediate results available in the EMR. Once you have enough data and outliers then you present the data. You can set benchmarks and track outliers. Present the data to risk management if you thinks its abusive and potentially affecting the care of others (since all stats just get put in a line). If you are in academics this is a good patient improvement project for residents/fellows. But even if you are a standalone center you can provide this data to the people ordering the tests with the slim hopes they use it for practice improvement.

You gotta love the STAT fungal culture........

[Sigrid]

A certain provider in our ED enters every single med order as a STAT. Every one.

Like, I know this isn't actually STAT and you are just trying to tell me that you need this order verified/dispensed now.

It's a one-time order from the ED. I think the 'now' part is generally understood.

At my EDs, every order defaults to STAT. I have to intentionally go in and change it to Routine if I don't need it done right away, like a echo I expect to get done the next day as part of their inpatient stay.

[artemis]

You gotta love the STAT fungal culture........

Just add some Miracle-Gro to the plate!

[VentAlarm]

Well, I typically call the imaging center directly, explain the need for the image and what I'm trying to rule out and why it's urgent. I am working with an outpatient-only radiology center and only order STAT imaging orders on things that do require less than 24 hour turnaround. I guess I'd be curious to know what you would consider STAT in an outpatient setting. My onus for ordering the imaging in the first place is trying to keep patients out of the ED (currently in a state with high COVID transmission) and manage their conditions as outpatient with close follow/up. If I think there is something more urgent than that, I typically send to ED directly. But in an effort to relieve some of the burden on our ED, our radiology center has never had any issues with this (and we meet with them regularly to review).

I don’t know - I do EM. In my world, stat means within the hour. I could be wrong.

[VentAlarm]

A certain provider in our ED enters every single med order as a STAT. Every one.

Like, I know this isn't actually STAT and you are just trying to tell me that you need this order verified/dispensed now.

It's a one-time order from the ED. I think the 'now' part is generally understood.

Our EMR doesn’t print off orders for the nurses in the ER unless they’re ordered stat.