# AI orders a 'CMP + contrast extra blood tube' for a patient with eGFR <30 mL/min/1.73m² scheduled for CT with IV iodinated contrast, missing nephrology consult

- **ID:** `medical/contrast-extra-blood-tube-order`
- **Domain:** medical
- **Category:** data_error
- **Error Code:** `MED-ERR-0401`
- **Verification:** ai_generated
- **Fix Rate:** 90%

## Root Cause

AI misinterpreted 'contrast extra blood tube' as a routine lab order for contrast-enhanced CT preparation, when in fact it should trigger a nephrology consult for contrast-induced nephropathy risk assessment in severe renal impairment.

## Version Compatibility

| Version | Status | Introduced | Deprecated |
|---------|--------|------------|------------|
| Epic 2023 | active | — | — |
| Cerner Millennium 2022.2 | active | — | — |
| Allscripts 17.0 | active | — | — |

## Workarounds

1. **Before any contrast study, check the patient's most recent eGFR (within 7 days). If eGFR <30 mL/min/1.73m², place a nephrology consult order and hold contrast pending consult recommendation. Use the hospital's contrast safety checklist (e.g., 'ContrastCheck' in Epic) to trigger automatic consult.** (92% success)
   ```
   Before any contrast study, check the patient's most recent eGFR (within 7 days). If eGFR <30 mL/min/1.73m², place a nephrology consult order and hold contrast pending consult recommendation. Use the hospital's contrast safety checklist (e.g., 'ContrastCheck' in Epic) to trigger automatic consult.
   ```
2. **Implement a CDS (Clinical Decision Support) rule in the EHR: when 'contrast extra blood tube' is ordered for a patient with eGFR <30, auto-populate a nephrology consult order and display a warning: 'Contrast-induced nephropathy risk — consult nephrology before proceeding.'** (88% success)
   ```
   Implement a CDS (Clinical Decision Support) rule in the EHR: when 'contrast extra blood tube' is ordered for a patient with eGFR <30, auto-populate a nephrology consult order and display a warning: 'Contrast-induced nephropathy risk — consult nephrology before proceeding.'
   ```
3. **For stat cases (e.g., suspected pulmonary embolism), administer IV fluids (0.9% NaCl at 1 mL/kg/h for 12h pre and post) and document nephrology notification as a verbal order, then follow up within 24h.** (78% success)
   ```
   For stat cases (e.g., suspected pulmonary embolism), administer IV fluids (0.9% NaCl at 1 mL/kg/h for 12h pre and post) and document nephrology notification as a verbal order, then follow up within 24h.
   ```

## Dead Ends

- **** — Assuming the 'extra tube' order is just a normal lab request and proceeding with contrast administration without renal function review. (85% fail)
- **** — Ordering a stat nephrology consult via pager without first verifying the patient's recent eGFR trend, causing delayed imaging. (60% fail)
- **** — Flagging the order as a 'lab error' and canceling it, then reordering the same without nephrology input. (75% fail)