Why Operators Should Be Standing by for Radiologists

2017-11-22
 

The theme of RSNA 2017 is “Explore. Invent. Transform.” Radiologists should explore why communicating imaging study results to referring physicians in a timely manner is often so difficult. But rather than inventing a new system to solve that challenge, radiologists should apply an old solution to eliminate an ongoing problem. That old solution, albeit upgraded and run on a state-of-the-art digital platform, is a centralized physician communication service.

Radiologists face three communication hurdles

Hidden from view for most patients is the daily challenge of getting in touch with referring providers and giving them the results from imaging tests they ordered for patients. The challenge is threefold:

  • Knowing who should be contacted with the results
  • Having the right contact information for those who should be contacted with the results
  • Actually contacting those who should be contacted with the results

That may seem trivial, especially to the general public that lives in a world of instant communication with anyone, anywhere. But for radiologists, it is anything but trivial.

There are many reasons. Patient-care teams are larger, so it’s difficult to know who to contact. Referring doctors work across multiple sites, making it difficult to know where they are on a specific day and time. Some forget to leave on-call information, give the on-call information to the wrong person, or don’t give the on-call information to everyone who needs to know it. Standard modes of communication such as texting and email are usually not secure and HIPAA-compliant. Hospitals are often notorious cell phone dead zones. 

The clinical consequences for radiologists and patients

The consequence for radiologists is spending far too much time on the phone trying to reach referring physicians with imaging results. That’s time better spent on reading and interpreting other tests.

For example, a recent study in the Journal of the American College of Radiology found that radiologists in radiology reading rooms on average are interrupted once every 12 minutes. Some 36 percent of the interruptions are from phone calls, pagers and other communication devices.

“Interruptions in reading rooms are highly disruptive,” the study said. “The majority of interruptions required radiologists to completely disengage from the cases being read.”

Clearly, the potential consequence for patients is much worse than it is for radiologists. Not only are radiologists distracted from the reading in front of them, they’re also struggling to convey to referring physicians information that’s either:

  • Critical: The patient is facing an immediate life-threatening situation.
  • Urgent: The patient is suffering from a medical situation that needs timely attention.
  • Unexpected or important: The patient has a previously undiagnosed condition or an important change in a previously diagnosed condition.

If communicating medical information is stalled, the patient could die, appropriate medical treatment could be delayed, or unnecessary medical treatment could be given.

How a centralized physician communication service works

To mitigate those clinical risks, radiologists and radiology practices and departments should consider creating a centralized physician communication service.

It’s not a new concept or function. Imagine a bank of switchboard operators sitting at big boards full of wires, taking calls over their headsets and plugging in two parties so they can talk. We’ve all seen it in old movies and television shows. Now imagine a digital version of that done through computer terminals at which a dedicated staff of operators connects radiologists with referring physicians.

The service is connected to a database or repository of imaging orders, patient names, patient medical records, referring physicians and up-to-date and real-time contact information. The radiologist notifies the operator through the system that he or she needs to reach the referring provider utilizing a single mouse click and indicates via a drop-down menu the urgency of that communication. The radiologist can then continue reading other studies, secure in the knowledge that the services is working to facilitate the communication, rather than wasting time on hold, looking up phone numbers, or talking to the wrong person. The operator contacts the referring provider, calls the radiologist and connects the two parties. If the contact information is incomplete or inaccurate, or, if the ordering provider is unavailable, escalation policies are put in place to be sure that care is delivered in a timely fashion no matter what.

The service does not handle or distribute any imaging results. It’s simply a conduit through which radiologists and referring physicians communicate in a timely manner.

The service can be created internally by redistributing existing resources or adding new resources. It can be done within a radiology department or more generally within an institution. The service also can be outsourced to a third-party vendor if internal resources and expertise are unavailable.

The system-wide benefits of a centralized physician communication service

The advantages of using a centralized physician communication service extend beyond the immediate benefits to patients and radiologists. Among the additional system-wide benefits are:

  • Ability to recruit and retain radiologists. Hospitals, health systems, and radiology practices and departments can attract radiologists with the promise of less wasted phone time and a reliable, systematic approach that ensures their imaging interpretations are reaching referring providers.
  • Clinical documentation support. Everything that flows through the system is tracked and time-stamped, such as:
    • When the radiologist contacted the service
    • What information was communicated to the service
    • When the provider was contacted
    • How long it took the provider to be contacted
    • When the provider and the radiologist discussed the test results

All that information should be documented anyway by the radiologist, but the service can fill in   any missing pieces and support what’s been documented in the patient’s record.

  • Use in wider quality-improvement efforts. Although the service seems simplistic on the surface, the data it collects can serve a much broader, organization-wide program to improve the quality and safety of patient care. The metrics collected can be used to help measure performance and flag gaps in care to be addressed. That can be done across an enterprise or by individual clinicians as part of the staff privilege and peer-review processes.

Considering the short- and long-term benefits, the question for radiologists and radiology practices and departments is why they haven’t centralized communications with referring doctors already. It’s a cost-effective approach that brings a return on investment documented by time and lives saved.

For more information on how a physician communication service can help your organization, contact Change Healthcare.

Leigh Shuman, M.D., is president of Oaklane Medical Imaging Consultants based in Lancaster, Pa. Lisa Manion, M.D., is senior physician executive, strategy and leadership, at Change Healthcare.

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