For physicians
Standing orders for screening
Selection by clinical impression is not reproducible and cannot be audited. A standing order set turns “who should we test” into a rule that staff can apply the same way every time.
What the order set collects at intake
Everything below is gathered before any decision about testing is made, because the decision rule depends on it.
Demographics and vitals
- Age, sex
- Height, weight, body mass index
- Abdominal girth — above 102 cm in men or 88 cm in women
- Blood pressure, heart rate, oxygen saturation
Symptom review
- Nerve pain, joint pain
- Fever or chills, recent respiratory, gastrointestinal or urinary symptoms
- Numbness, burning, tingling
- Dizziness, unsteadiness, falls
- Claudication or reduced walking distance
History
- Personal history of cancer, type 2 diabetes, angina, transient ischemic attack
- Hypertension, thyroid disease, or treatment for either
- Antidepressant, anxiety or post-traumatic stress treatment
- Addiction risk or current opioid use
- Social history: alcohol, tobacco, substance use
- Family history: diabetes, cardiovascular disease, hypertension, stroke, cancer
The decision rule
Testing is indicated where any one of the following is true.
- Age over 50 with at least one cardiovascular risk factor.
- Age over 70, irrespective of risk factors.
- Hypertension, treated or untreated.
- Body mass index above 30, or abdominal girth above the thresholds above at any body mass index.
- Current or former tobacco use.
- Diabetes or impaired glucose tolerance.
- Any symptom from the neuropathic, autonomic, claudication or unsteadiness clusters, at any age.
Three or more metabolic syndrome traits present at intake is a separate trigger, and one worth recording explicitly because it is a defensible, auditable reason for the assessment.
Why a written rule beats clinical judgment here
- It is reproducible. Two staff members applying the same rule select the same patients. Two clinicians applying impression do not.
- It is auditable. Under any quality program, evidence that a defined activity was applied across a population is worth more than evidence that individual decisions were made well. Quality reporting.
- It removes the selection bias that hides disease. The patients who most need measuring are frequently the least likely to raise it, because their symptoms are painless and they have already adapted to them.
- It protects clinic time. Staff can apply the rule without interrupting a physician for each decision.
What the order set should not do
It should not order everything for everyone. The suite is modular and the studies indicated by burning feet are not the studies indicated by unsteadiness. The order set selects the patient; a clinician selects the panel. Selection criteria covers the second half.
For patients: the same subject written for the person having the assessment is at who should be tested.
Talk to someone about testing
Tell us what you are trying to find out and we will explain which Measura assessments answer that question, what each one involves, and how the results are reviewed with a clinician.
4477 Woodson Rd, Suite 201, St. Louis, MO 63134. Monday to Friday, 9:00 a.m. to 5:00 p.m. Please do not send symptoms, diagnoses or images through a web form — a website form is not a secure medical channel. Call us with clinical detail.
Common questions
Who is allowed to apply a standing order?
That depends on state scope-of-practice rules and on how the order is written, and it should be settled before implementation. Standing orders in practice.
Does a standing order commit us to testing everyone who qualifies?
No. It identifies candidates; the clinical decision to test remains a decision. The criteria.
How do we audit whether it is being applied?
Count qualifying patients against tested patients over a period; the gap is the finding. Read more.
Medically reviewed by Dr. Gurpreet Singh Padda, MD, MBA, MHP, medical director of Measura. Last reviewed .