Radiologists Need Proper Tools to Follow-Up on Findings


Healthcare communicationSurgeons likely think that patient care centers on the scalpel, while radiologists think it’s about the scans and nurses believe it’s about bedside manner and being attuned to patient needs.

Patient care certainly is all of those things and many more. But at its very core, patient care is all about communication:

  • Patients communicating their symptoms and family history to physicians
  • Physicians communicating diagnoses to patients or communicating about needed tests and scans to the necessary providers
  • Technicians performing scans and radiologists interpreting the results and communicating that to physicians
  • Nurses communicating with patients about their comfort and about upcoming tests and procedures

I’m sure you get the point. Recent research from the Journal of the American College of Radiology and Boston Medical Center, however, points to a glaring lapse of communication between radiologists and physicians over incidental findings.

You’re likely aware that a 2014 study in the Journal of the American College of Radiology showed that follow up did not occur 29% of the time when incidental pulmonary nodules were found on CT pulmonary angiographic studies ordered by the ED. When nodules were mentioned only in the findings section of the report, no follow-up occurred.

A study of 6,851 patient reports generated in one month at Boston Medical Center showed that 33% of radiologist recommendations were not followed, study investigator Alexander Norbash, MD reported last month (April) at the American Roentgen Ray Society annual meeting. Of the recommendations that weren’t adhered to, 39% were not acknowledged in the referring physician’s notes – even though 43% were judged to be significant according to Dr. Norbash and his colleagues.

As well, in a recent article, Dr. Evan Kaminer, stated requests from emergency room physicians for reads have increased exponentially. In fact the use of CT, MRI, ultrasound and nuclear medicating scans at his facility’s ER has increased by 30% in the past few years. In this community based hospital, efforts are made to evaluate patients in a timely manner and the results reported in the Hospital Consumer Assessment of healthcare Providers and Systems.

The American College of Radiology (ACR) recognized the importance of communicating diagnostic findings in a 2014 practice parameter document that noted that, “quality patient care can only be achieved when study results are conveyed in a timely fashion to those responsible for treatment decisions.”

Further, ACR noted that effective communication should:

  1. Promote optimal patient care and support the ordering physician/provider
  2. Be timely
  3. Minimize the risk of communication errors

Redefining the role of radiologists
Radiologists are struggling for relevance in an increasingly value-based reimbursement world due to a lack of performance metrics. They can either wait for CMS to issue value-based metrics for radiology that likely will come from people outside the profession or they can start being proactive and innovative, developing their own quality and value-based metrics.The significantly large number of recommendations made by radiologists that are not acknowledged or followed up on is a great place to start.

What if radiologists had access to a tool that could not only help prevent missed or delayed communications but also support value-based care? Conserus Workflow Intelligence is a radiology workflow solution that allows radiologists to create any number of workflows seamlessly into their normal workflow. For example, radiologists can create an actionable findings workflow to quickly and easily communicate critical, urgent, and incidental findings to support staff and/or the referring physician. They can also create a follow-up tracking workflow that can alert the ordering physician of follow-up recommendations. The system will maintain and automate a “tickler file” alert system so actionable communications don’t fall through the cracks.

In fact, in the same article, Dr. Kaminer relays that Conserus Workflow Intelligence did improve performance for both ER and ICU. For the ER, average turnaround time for CT, MRI and ultrasound reads decreased 35% and turnaround time for ICU decreased 50%.

The old adage, “The best defense is a good offense,” definitely applies here. It’s much better for patients and for radiologists to ensure that the ordering physician is aware of all the relevant findings in the radiology report, not just the highlights. In many cases, the incidental findings may be nothing. But in those instances where the incidental findings turn out to be more serious, successful follow up often translates to saved lives and improved outcomes.

For more information about Conserus, visit us during SIIM (Portland, ORE, June 29- July 1) or contact us. Keep up with the latest radiology workflow news by subscribing to the Medical Imaging Talk Blog. Or by visiting the website.

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