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Lacson R, Pianykh O, Hartmann S, Johnston H, Daye D, Flores E, Kapoor N, Khorasani R. Factors Associated With Timeliness and Equity of Access to Outpatient MRI Examinations. J Am Coll Radiol 2024; 21:1049-1057. [PMID: 38215805 DOI: 10.1016/j.jacr.2023.12.028] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/07/2023] [Revised: 12/26/2023] [Accepted: 12/27/2023] [Indexed: 01/14/2024]
Abstract
OBJECTIVE The role of MRI in guiding patients' diagnosis and treatment is increasing. Therefore, timely MRI performance prevents delays that can impact patient care. We assessed the timeliness of performing outpatient MRIs using the socio-ecological model approach and evaluated multilevel factors associated with delays. METHODS This institutional review board-approved study included outpatient MRI examinations ordered between October 1, 2021, and December 31, 2022, for performance at a large quaternary care health system. Mean order-to-performed (OtoP) interval (in days) and prolonged OtoP interval (defined as >10 days) for MRI orders with an expected date of 1 day to examination performance were measured. Logistic regression was used to assess patient-level (demographic and social determinants of health), radiology practice-level, and community-level factors associated with prolonged OtoP interval. RESULTS There were 126,079 MRI examination orders with expected performance within 1 day placed during the study period (56% of all MRI orders placed). After excluding duplicates, there were 97,160 orders for unique patients. Of the MRI orders, 48% had a prolonged OtoP interval, and mean OtoP interval was 18.5 days. Factors significantly associated with delay in MRI performance included public insurance (odds ratio [OR] = 1.11, P < .001), female gender (OR = 1.11, P < .001), radiology subspecialty (ie, cardiac, OR = 1.71, P < .001), and patients from areas that are most deprived (ie, highest Area Deprivation Index quintile, OR = 1.70, P < .001). DISCUSSION Nearly half of outpatient MRI orders were delayed, performed >10 days from the expected date selected by the ordering provider. Addressing multilevel factors associated with such delays may help enhance timeliness and equity of access to MRI examinations, potentially reducing diagnostic errors and treatment delays.
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Affiliation(s)
- Ronilda Lacson
- Associate Director, Center for Evidence Based Imaging, Department of Radiology, Brigham and Women's Hospital, Boston, Massachusetts, and Associate Professor of Radiology, Harvard Medical School, Boston, Massachusetts.
| | - Oleg Pianykh
- Assistant Professor of Radiology, Harvard Medical School, Boston, Massachusetts; and Director of Medical Analytics, Department of Radiology, Massachusetts General Hospital, Boston, Massachusetts
| | - Sean Hartmann
- Department of Radiology, Massachusetts General Hospital, Boston, Massachusetts
| | - Heather Johnston
- Department of Radiology, Massachusetts General Hospital, Boston, Massachusetts
| | - Dania Daye
- Assistant Professor of Radiology, Harvard Medical School, Boston, Massachusetts; and Quality Director, Interventional Radiology Division, and Co-Director of IR Research, Division of Vascular and Interventional Radiology, Department of Radiology, Massachusetts General Hospital, Boston, Massachusetts
| | - Efren Flores
- Department of Radiology, Massachusetts General Hospital, Boston, Massachusetts; Associate Professor of Radiology, Harvard Medical School, Boston, Massachusetts; and Vice Chair, Diversity, Equity & Inclusion, Mass General Brigham, Boston, Massachusetts; Vice Chair of Radiology, Distinguished Chair, Medical Informatics, and Director of Center for Evidence-Based Imaging, Department of Radiology, Brigham and Women's Hospital, Boston, Massachusetts; Professor of Radiology, Harvard Medical School, Boston, Massachusetts; and Vice Chair, Radiology Quality and Safety, Mass General Brigham, Boston, Massachusetts
| | - Neena Kapoor
- Director of Diversity, Inclusion, and Equity and Quality and Safety Officer, Department of Radiology, Department of Radiology, Brigham and Women's Hospital, Boston, Massachusetts; and Assistant Professor of Radiology, Harvard Medical School, Boston, Massachusetts
| | - Ramin Khorasani
- Vice Chair of Radiology, Distinguished Chair, Medical Informatics, and Director of Center for Evidence-Based Imaging, Department of Radiology, Brigham and Women's Hospital, Boston, Massachusetts; Professor of Radiology, Harvard Medical School, Boston, Massachusetts; and Vice Chair, Radiology Quality and Safety, Mass General Brigham, Boston, Massachusetts
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Felsen A, McClelland A, Kobi M, Bello JA, Burns J. Health Systems Science - A Primer for Radiologists. Acad Radiol 2023; 30:2079-2088. [PMID: 36966069 DOI: 10.1016/j.acra.2023.02.025] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/22/2022] [Revised: 02/13/2023] [Accepted: 02/16/2023] [Indexed: 03/27/2023]
Abstract
Health systems science (HSS) is an educational framework designed to promote improved care through enhanced citizenship and the training of systems-fluent individuals trained in the science of health care delivery. HSS education in residency builds upon foundations established during medical school, emphasizing practical skills development, and fostering a growth mindset among trainees. The HSS framework organizes elements of system-based practice for radiology trainees, promoting practice-readiness for providing safe, timely, effective, efficient, equitable and patient centered radiological care. This paper serves as a primer for radiologists to understand and apply the HSS framework. Additionally, we highlight radiology-specific curricular elements aligned with the HSS framework, and provide teaching resources both for classroom education and for resident self-study.
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Affiliation(s)
- Amanda Felsen
- Albert Einstein College of Medicine, Montefiore New Rochelle Hospital; Bronx, NY
| | - Andrew McClelland
- Department of Radiology, NYU Grossman School of Medicine; New York, NY
| | - Mariya Kobi
- Department of Radiology, Columbia University Medical Center; New York, NY
| | | | - Judah Burns
- Department of Radiology, Montefiore Medical Center; Bronx, NY; Albert Einstein College of Medicine; Bronx, NY.
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White T, Aronson MD, Sternberg SB, Shafiq U, Berkowitz SJ, Benneyan J, Phillips RS, Schiff GD. Analysis of Radiology Report Recommendation Characteristics and Rate of Recommended Action Performance. JAMA Netw Open 2022; 5:e2222549. [PMID: 35867062 PMCID: PMC9308057 DOI: 10.1001/jamanetworkopen.2022.22549] [Citation(s) in RCA: 13] [Impact Index Per Article: 6.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/01/2023] Open
Abstract
IMPORTANCE Following up on recommendations from radiologic findings is important for patient care, but frequently there are failures to carry out these recommendations. The lack of reliable systems to characterize and track completion of actionable radiology report recommendations poses an important patient safety challenge. OBJECTIVES To characterize actionable radiology recommendations and, using this taxonomy, track and understand rates of loop closure for radiology recommendations in a primary care setting. DESIGN, SETTING, AND PARTICIPANTS Radiology reports in a primary care clinic at a large academic center were redesigned to include actionable recommendations in a separate dedicated field. Manual review of all reports generated from imaging tests ordered between January 1 and December 31, 2018, by primary care physicians that contained actionable recommendations was performed. For this quality improvement study, a taxonomy system that conceptualized recommendations was developed based on 3 domains: (1) what is recommended (eg, repeat a test or perform a different test, specialty referral), (2) specified time frame in which to perform the recommended action, and (3) contingency language qualifying the recommendation. Using this framework, a 2-stage process was used to review patients' records to classify recommendations and determine loop closure rates and factors associated with failure to complete recommended actions. Data analysis was conducted from April to July 2021. MAIN OUTCOMES AND MEASURES Radiology recommendations, time frames, and contingencies. Rates of carrying out vs not closing the loop on these recommendations in the recommended time frame were assessed. RESULTS A total of 598 radiology reports were identified with structured recommendations: 462 for additional or future radiologic studies and 196 for nonradiologic actions (119 specialty referrals, 47 invasive procedures, and 43 other actions). The overall rate of completed actions (loop closure) within the recommended time frame was 87.4%, with 31 open loop cases rated by quality expert reviewers to pose substantial clinical risks. Factors associated with successful loop closure included (1) absence of accompanying contingency language, (2) shorter recommended time frames, and (3) evidence of direct radiologist communication with the ordering primary care physicians. A clinically significant lack of loop closure was found in approximately 5% of cases. CONCLUSIONS AND RELEVANCE The findings of this study suggest that creating structured radiology reports featuring a dedicated recommendations field permits the development of taxonomy to classify such recommendations and determine whether they were carried out. The lack of loop closure suggests the need for more reliable systems.
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Affiliation(s)
- Tiantian White
- Harvard Medical School, Boston, Massachusetts
- Department of Family Medicine, Oregon Health & Science University, Portland
| | - Mark D. Aronson
- Department of Medicine, Beth Israel Deaconess Medical Center, Boston, Massachusetts
| | - Scot B. Sternberg
- Department of Medicine, Beth Israel Deaconess Medical Center, Boston, Massachusetts
| | - Umber Shafiq
- Department of Medicine, Beth Israel Deaconess Medical Center, Boston, Massachusetts
| | - Seth J. Berkowitz
- Harvard Medical School, Boston, Massachusetts
- Department of Radiology, Beth Israel Deaconess Medical Center, Boston, Massachusetts
| | - James Benneyan
- Healthcare Systems Engineering Institute, College of Engineering, Northeastern University, Boston, Massachusetts
| | - Russell S. Phillips
- Department of Medicine, Beth Israel Deaconess Medical Center, Boston, Massachusetts
- Harvard Medical School, Center for Primary Care, Boston, Massachusetts
| | - Gordon D. Schiff
- Harvard Medical School, Center for Primary Care, Boston, Massachusetts
- Center for Patient Safety Research and Practice, Brigham and Women’s Hospital, Boston, Massachusetts
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Talking Points: Enhancing Communication Between Radiologists and Patients. Acad Radiol 2022; 29:888-896. [PMID: 33846062 DOI: 10.1016/j.acra.2021.02.026] [Citation(s) in RCA: 6] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/25/2021] [Revised: 02/15/2021] [Accepted: 02/21/2021] [Indexed: 11/23/2022]
Abstract
Radiologists communicate along multiple pathways, using written, verbal, and non-verbal means. Radiology trainees must gain skills in all forms of communication, with attention to developing effective professional communication in all forms. This manuscript reviews evidence-based strategies for enhancing effective communication between radiologists and patients through direct communication, written means and enhanced reporting. We highlight patient-centered communication efforts, available evidence, and opportunities to engage learners and enhance training and simulation efforts that improve communication with patients at all levels of clinical care.
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Voreis S, Mattay G, Cook T. Informatics Solutions to Mitigate Legal Risk Associated With Communication Failures. J Am Coll Radiol 2022; 19:823-828. [PMID: 35654145 DOI: 10.1016/j.jacr.2022.05.002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/09/2022] [Revised: 05/06/2022] [Accepted: 05/09/2022] [Indexed: 11/25/2022]
Abstract
Communication failures are a documented cause of malpractice litigation against radiologists. As imaging volumes have increased, and with them the number of findings requiring further workup, radiologists are increasingly expected to communicate with ordering clinicians. However, communication may be unsuccessful for a variety of reasons that expose radiologists to potential malpractice risk. Informatics solutions have the potential to improve communication and decrease this risk. We discuss human-powered, purely automated, and hybrid approaches to closing the communications loop. In addition, we describe the Patient Test Results Information Act (Pennsylvania Act 112) and its implications for closing the loop on noncritical actionable findings.
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Affiliation(s)
- Shahodat Voreis
- Department of Radiology, Perelman School of Medicine at the University of Pennsylvania, Philadelphia, Pennsylvania
| | - Govind Mattay
- John T. Milliken Department of Medicine, Washington University School of Medicine, St Louis, Missouri
| | - Tessa Cook
- Department of Radiology, Perelman School of Medicine at the University of Pennsylvania, Philadelphia, Pennsylvania; Chief, 3-D and Advanced Imaging; Codirector, Center for Practice Transformation in Radiology; Fellowship Director, Imaging Informatics; Member, ACR Informatics Commission; Vice Chair, ACR Commission on Patient- and Family-Centered Care; Past Cochair, ACR Informatics Summit.
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6
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The awareness of radiologists for the presence of lateral lymph nodes in patients with locally advanced rectal cancer: a single-centre, retrospective cohort study. Eur Radiol 2022; 32:6637-6645. [PMID: 35581479 PMCID: PMC9474434 DOI: 10.1007/s00330-022-08840-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/01/2022] [Revised: 04/14/2022] [Accepted: 04/25/2022] [Indexed: 11/30/2022]
Abstract
Objectives Enlarged lateral lymph nodes (LLNs) are associated with increased (lateral) local recurrence rates. Size and anatomical location should therefore always be reported by radiologists and discussed during multidisciplinary meetings. The objective was to investigate how often LLNs are mentioned in MRI reports in a tertiary referral centre. Methods A single - centre, retrospective study of 202 patients treated for primary rectal cancer between 2012 and 2020, with at least a T2 tumour located within 12cm of the anorectal junction. The radiology reports were written by 30–40 consultant radiologists. MRI scans were independently re-assessed by an expert radiologist. The primary outcome was how often the presence or absence of LLNs was mentioned in the initial report. Results Primary MRI reports explicitly mentioned the presence or absence of LLNs in 89 (44%) cases. Of the 43 reports with present LLNs, only one (1%) reported on all features such as size, location or malignant features. Expert review revealed 17 LLNs which were ≥ 7 mm (short-axis); two of these were not mentioned in the original reports. In 14/43 (33%) cases, LLNs were discussed during the primary multidisciplinary meeting, while 17/43 (40%) restaging MRI reports failed to report on the previously visible LLN. Reporting LLNs increased significantly with higher N-stage (p = .010) and over time (p = .042). Conclusions Though improving with time, there is still limited consistency in reporting LLNs. Only 44% of primary MRI reports mentioned LLNs and relevant features of those LLNs were seldomly reported. Given the importance of this information for subsequent treatment; increased awareness, proper training and the use of templates are needed. Key Points • Comprehensive reporting of lateral lymph nodes in primary MRI reports was limited to less than 50%. • Lateral lymph nodes are not always discussed during primary multidisciplinary meetings or mentioned in restaging reports. • Improvements in the awareness and knowledge of lateral lymph nodes are needed to ensure adequate multidisciplinary treatment decisions.
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Wynn JD. Coping With Radiology Malpractice Litigation. J Am Coll Radiol 2022; 19:829-833. [PMID: 35341698 DOI: 10.1016/j.jacr.2022.01.020] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/25/2021] [Revised: 12/22/2021] [Accepted: 01/04/2022] [Indexed: 11/26/2022]
Affiliation(s)
- John David Wynn
- private practice and is a Clinical Professor, Department of Psychiatry, University of Washington School of Medicine, Seattle, Washington.
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Ahn TR, Jeong YM, Park SH, Jeon JY, Lee SW, Shim YS. Analysis of critical report notification from musculoskeletal radiology in a tertiary academic medical institution with a regional trauma center. PLoS One 2022; 17:e0262511. [PMID: 35025970 PMCID: PMC8758081 DOI: 10.1371/journal.pone.0262511] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/04/2021] [Accepted: 12/28/2021] [Indexed: 11/18/2022] Open
Abstract
Purpose We aimed to analyze the prevalence, causes, and clinical settings of 4-year critical radiologic reports (CRRs) notified from the musculoskeletal section of the radiology department. Then, we investigated the communication outcomes. Methods This study was approved by our institutional review board. We retrospectively included 175 musculoskeletal CRRs from our database between January 2017 and December 2020. The CRRs were analyzed by two musculoskeletal radiologists, who categorized the CRRs by clinical setting (emergency department(ED) patient, outpatient, and inpatient), body part, type of image modality, reason for CRR, incidental lesion, and clinical outcome. The clinical outcome was retrieved from the electronic medical records. Results The 175 musculoskeletal CRRs accounted for 5.4% of the CRRs (n = 3217) available in the study period. Most CRRs (94.9%, 166/175) corresponded to the musculoskeletal system, while the remaining ones (5.1%, 9/175) corresponded to the non-musculoskeletal system. In addition, the spine, extremities, and thoracic cage accounted for 52.6%, 40.6%, and 1.7% of the musculoskeletal CRRs, respectively. Moreover, most patients presented to the ED (50.3%, 88/175), followed by inpatients (30.9%, 54/175), and outpatients (18.9%, 33/175). The CRR reasons included missed fracture (54.3%), suspected malignancy (16%), clinical emergency (10.3%), unexpected infection/inflammation (11.4%), and others (8%). Furthermore, 11 (6.3%) incidental lesions were not related to the primary imaging purpose. Referring clinicians actively acknowledged 80% of the CRRs. The loss to follow-up action was the highest in the ED patients (35.2%, 31/88; p < 0.001), being significantly higher than that in outpatients (6.1%, 2/33) and inpatients (3.7%, 2/54). Conclusion Missed fractures were the most common cause of musculoskeletal CRRs. ED showed prevalence in musculoskeletal CRRs and reflected the highest loss to follow-up action. ED physicians should pay more attention to CRRs to enhance patient care.
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Affiliation(s)
- Tae Ran Ahn
- Department of Radiology, Gil Medical Center, Gachon University College of Medicine, Incheon, Republic of Korea
| | - Yu Mi Jeong
- Department of Radiology, Gil Medical Center, Gachon University College of Medicine, Incheon, Republic of Korea
- * E-mail:
| | - So Hyun Park
- Department of Radiology, Gil Medical Center, Gachon University College of Medicine, Incheon, Republic of Korea
| | - Ji Young Jeon
- Department of Radiology, Gil Medical Center, Gachon University College of Medicine, Incheon, Republic of Korea
| | - Sheen-Woo Lee
- Department of Radiology, Gil Medical Center, Gachon University College of Medicine, Incheon, Republic of Korea
| | - Young Sup Shim
- Department of Radiology, Gil Medical Center, Gachon University College of Medicine, Incheon, Republic of Korea
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Donners R, Gutzeit A, Gehweiler JE, Manneck S, Kovacs BK, Harder D. Orthopaedic surgeons do not consult radiology reports. Fact or fiction? Eur J Radiol 2021; 142:109870. [PMID: 34304032 DOI: 10.1016/j.ejrad.2021.109870] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/08/2021] [Revised: 07/14/2021] [Accepted: 07/15/2021] [Indexed: 11/28/2022]
Abstract
PURPOSE To find out how orthopaedic surgeons handle radiological reports and to identify ways to improve musculoskeletal radiology service and interdisciplinary communication. METHOD An anonymised 14-question online survey was distributed among 27 orthopaedic departments in German-speaking parts of Europe. It was available to trainees and consultants between 22/10/2020 and 05/06/2021. The questionnaire collected information regarding the participants' habits of consulting radiology reports depending on the imaging modality, reasons for not reading reports and asked for improvement recommendations for the radiology service. RESULTS 81 orthopaedists participated. 20% would never consult a plain radiograph report. In contrast, only 4% would never consult a CT report and no one claimed to never consult an MRI report. 43%, 67% and 86% would routinely consult radiology reports of radiographs, CT and MRI studies, respectively. Long time to report availability (24%), a general lack of time (19%) and too long texts (17%) were the most popular reasons for not consulting the reports. 62% of participants voted to sometimes disagree with the reports and in cases of opinion discrepancy 51% would always or often contact the radiologist. 64% preferred to be informed directly via phone about relevant unexpected findings. Most popular report improvement recommendations were more rapid report availability (24%), inclusion of significant images (19%) and inclusion of more angle and distance measurements (16%). In the free text column, a desire for direct interdisciplinary discussion of equivocal cases was often stated (30%). CONCLUSIONS Concluding, this survey showed that orthopaedic surgeons routinely consult radiology reports. The participants expressed a desire for increased, direct interdisciplinary communication to solve equivocal cases and improve patient care.
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Affiliation(s)
- Ricardo Donners
- Department of Radiology, University Hospital Basel, University of Basel, Petersgraben 4, CH-4031 Basel, Switzerland; Department of Radiology, Royal Marsden Hospital Downs Road, SM2 5PT Sutton, UK.
| | - Andreas Gutzeit
- Institute of Radiology and Nuclear Medicine and Breast Center St. Anna, Hirslanden Klinik St. Anna, St. Anna-Strasse 32, 6006 Lucerne, Switzerland; Department of Chemistry and Applied Biosciences, Institute of Pharmaceutical Sciences, ETH Zurich, Vladimir-Prelog-Weg 1-5 / 10, 8093 Zurich, Switzerland; Department of Radiology, Paracelsus Medical University, Salzburg, Austria.
| | - Julian E Gehweiler
- Department of Radiology, University Hospital Basel, University of Basel, Petersgraben 4, CH-4031 Basel, Switzerland.
| | - Sebastian Manneck
- Department of Radiology, University Hospital Basel, University of Basel, Petersgraben 4, CH-4031 Basel, Switzerland.
| | - Balazs K Kovacs
- Department of Radiology, University Hospital Basel, University of Basel, Petersgraben 4, CH-4031 Basel, Switzerland.
| | - Dorothee Harder
- Department of Radiology, University Hospital Basel, University of Basel, Petersgraben 4, CH-4031 Basel, Switzerland.
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Walters GK. The Perfect Storm: Exam of a Medical Error and Factors Contributing to Its Possible Escalation. J Patient Saf 2021; 17:e264-e267. [PMID: 33871415 DOI: 10.1097/pts.0000000000000846] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
OBJECTIVE After an initial medical misadventure, failure of recognition and continuing factors that could perpetuate the error are examined. METHODS A critical evaluation of the continuum of care after the initial error was conducted through chart review and comparison to published standards. RESULTS Analysis of the continuum of care after the original error demonstrated numerous system failures that should have alerted the providers to the initial error. DISCUSSION Technology, electronic medical records, lack of critical communications, and short cuts have the potential to not recognize patient care safety issues and potential harm. CONCLUSIONS Medical errors are multifactorial. Blame casting and accusations are not productive. Critical analysis of systems/processes, current technology, eliminating shortcuts, and critical communications may increase patient safety.
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Affiliation(s)
- Gerald K Walters
- From the Johns Hopkins Bayview Medical Center, Baltimore, Maryland
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11
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Noguchi T, Tanaka K, Okada Y, Fukuizumi K, Yokoda S, Dairiki M, Yamashita K, Shin S, Wada N, Harada S, Morita S. A practical system that enables physicians to respond expeditiously to significant unexpected findings (SUFs) in radiological reports. Jpn J Radiol 2021; 39:424-432. [PMID: 33386574 DOI: 10.1007/s11604-020-01077-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/27/2020] [Accepted: 11/22/2020] [Indexed: 10/22/2022]
Abstract
PURPOSE To demonstrate effectiveness of our present radiological report check flowchart enabling physicians to respond to significant unexpected findings (SUFs), by comparing the response periods from the examination date to the action date on untreated SUFs between the previous and present versions of our flowchart. METHODS In the flowchart's previous version used February-October 2019, SUFs, which were notified by email, were audited every month. The physician received a phone call and was asked to act on the untreated SUF. In the flowchart's present version used from November 2019 to May 2020, SUFs were audited every 2 weeks. The physician and his/her chief were asked to return a written response to the untreated SUF. We evaluated the difference in the response periods between the previous and present versions of the flowchart. RESULTS With the previous flowchart's use, untreated SUFs were 43 of 229 SUFs (18.8%) with the present flowchart untreated SUFs were 22 of 130 SUFs (16.9%). All SUFs in both periods were eventually responded. The present flowchart (median/range, 25/11-70 days) significantly had shorter response periods than the previous flowchart (70/16-290 days) (p < 0.0001). CONCLUSION The present flowchart employing a shortened primary audit interval, a written response, and the department chief's intervention, helped reduce the response periods.
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Affiliation(s)
- Tomoyuki Noguchi
- Department of Radiology, National Hospital Organization Kyushu Medical Center, 1-8-1 Jigyohama, Chuo-ku, Fukuoka City, Fukuoka Province, Japan. .,Department of Clinical Research, National Hospital Organization Kyushu Medical Center, 1-8-1 Jigyohama, Chuo-ku, Fukuoka City, Fukuoka Province, Japan. .,Education and Training Office, Department of Clinical Research, Center for Clinical Sciences, National Center for Global Health and Medicine, 1-21-1 Toyama, Shinjuku-ku, Tokyo, Japan.
| | - Kumi Tanaka
- Medical Safety Management Unit, National Hospital Organization Kyushu Medical Center, 1-8-1 Jigyohama, Chuo-ku, Fukuoka City, Fukuoka Province, Japan.,Department of Nursing, National Hospital Organization Kokura Medical Center, 10-10 Harugaoka, Kokuraminami-ku, Kitakyushu City, Fukuoka Province, Japan
| | - Yasushi Okada
- Medical Safety Management Unit, National Hospital Organization Kyushu Medical Center, 1-8-1 Jigyohama, Chuo-ku, Fukuoka City, Fukuoka Province, Japan
| | - Kunitaka Fukuizumi
- Medical Information Management Center, National Hospital Organization Kyushu Medical Center, 1-8-1 Jigyohama, Chuo-ku, Fukuoka City, Fukuoka Province, Japan
| | - Sachiyo Yokoda
- Medical Safety Management Unit, National Hospital Organization Kyushu Medical Center, 1-8-1 Jigyohama, Chuo-ku, Fukuoka City, Fukuoka Province, Japan.,Department of Nursing, National Hospital Organization Kyushu Medical Center, 1-8-1 Jigyohama, Chuo-ku, Fukuoka City, Fukuoka Province, Japan
| | - Motoko Dairiki
- Medical Safety Management Unit, National Hospital Organization Kyushu Medical Center, 1-8-1 Jigyohama, Chuo-ku, Fukuoka City, Fukuoka Province, Japan.,Department of Nursing, National Hospital Organization Kyushu Medical Center, 1-8-1 Jigyohama, Chuo-ku, Fukuoka City, Fukuoka Province, Japan
| | - Koji Yamashita
- Department of Radiology, National Hospital Organization Kyushu Medical Center, 1-8-1 Jigyohama, Chuo-ku, Fukuoka City, Fukuoka Province, Japan
| | - Seitaro Shin
- Department of Radiology, National Hospital Organization Kyushu Medical Center, 1-8-1 Jigyohama, Chuo-ku, Fukuoka City, Fukuoka Province, Japan
| | - Noriaki Wada
- Department of Radiology, National Hospital Organization Kyushu Medical Center, 1-8-1 Jigyohama, Chuo-ku, Fukuoka City, Fukuoka Province, Japan
| | - Shino Harada
- Department of Radiology, National Hospital Organization Kyushu Medical Center, 1-8-1 Jigyohama, Chuo-ku, Fukuoka City, Fukuoka Province, Japan
| | - Shigeki Morita
- The Director of the hospital, National Hospital Organization Kyushu Medical Center, 1-8-1 Jigyohama, Chuo-ku, Fukuoka City, Fukuoka Province, Japan
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12
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Small L. The role of clinical history in the interpretation of chest radiographs. Radiography (Lond) 2020; 27:698-703. [PMID: 33158752 DOI: 10.1016/j.radi.2020.10.003] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/09/2020] [Revised: 10/01/2020] [Accepted: 10/03/2020] [Indexed: 10/23/2022]
Abstract
OBJECTIVE This review will appraise the literature pertaining to the influences that clinical history has on the action of assessing the chest radiograph. KEY FINDINGS There remains conflicting evidence on the impact of clinical history on chest radiography. Some research suggests that clinical history has the potential to influence the reporter in a negative way by limiting their search strategy to a more focussed search. Image interpretation is more accurate when reporters are allowed to conduct a free search of the chest image, untainted by preconceived concepts. CONCLUSION Clinical history needs to be accessed appropriately to aid and not stifle accurate image interpretation. Reporters need to be aware of the potential bias clinical history can introduce to their reporting and develop strategies to alleviate this as much as possible. IMPLICATIONS FOR PRACTICE A greater understanding of the potential bias of clinical history on the process of image interpretation is required by all reporters. Reporters need to develop an approach and strategy when accessing clinical history. Novice reporters need to be educated regarding the impact of clinical history on their reporting.
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Affiliation(s)
- L Small
- University Hosiptals Birmingham, Imaging Department, Birmingham, B9 5SS, United Kingdom.
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Towbin AJ, Smith RL, Smith EA, Brown J, Care MM, Calvo-Garcia MA, Coley BD, Dillman JR, England D, Gramke M, Howard B, Koch BL, Kraus SJ, Leopard AC, Li Y, Merrow AC, O’Brien S, Schmitz JA, Sharp SE, Szabados A, Vogelsang TA, Walton K, Wieland CA, Wiesman BA. RESPECT: Radiology Employees Striving for Productive and Effective Communication. Radiographics 2020; 40:2068-2079. [DOI: 10.1148/rg.2020200041] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Affiliation(s)
- Alexander J. Towbin
- From the Department of Radiology, Cincinnati Children’s Hospital, 3333 Burnet Ave, MLC 5031, Cincinnati, OH 45229 (A.J.T., R.L.S., E.A.S.); and Department of Radiology, University of Cincinnati College of Medicine, Cincinnati, Ohio (A.J.T., E.A.S.)
| | - Rachel L. Smith
- From the Department of Radiology, Cincinnati Children’s Hospital, 3333 Burnet Ave, MLC 5031, Cincinnati, OH 45229 (A.J.T., R.L.S., E.A.S.); and Department of Radiology, University of Cincinnati College of Medicine, Cincinnati, Ohio (A.J.T., E.A.S.)
| | - Ethan A. Smith
- From the Department of Radiology, Cincinnati Children’s Hospital, 3333 Burnet Ave, MLC 5031, Cincinnati, OH 45229 (A.J.T., R.L.S., E.A.S.); and Department of Radiology, University of Cincinnati College of Medicine, Cincinnati, Ohio (A.J.T., E.A.S.)
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14
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Visser JJ, de Vries M, Kors JA. Assessment of actionable findings in radiology reports. Eur J Radiol 2020; 129:109109. [PMID: 32521309 DOI: 10.1016/j.ejrad.2020.109109] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/27/2020] [Revised: 05/20/2020] [Accepted: 05/31/2020] [Indexed: 12/21/2022]
Abstract
PURPOSE The American College of Radiology (ACR) Actionable Reporting Work Group defined three categories of imaging findings that require additional, nonroutine communication with the referring physician because of their urgency or unexpectedness. The objective of this study was to determine the prevalence of actionable findings in radiology reports, and to assess how well radiologists agree on the categorisation of actionable findings. METHOD From 124,909 consecutive radiology reports stored in the electronic health record system of a large university hospital, 1000 reports were randomly selected. Two radiologists independently annotated all actionable findings according to the three categories of urgency defined by the ACR Work Group. Annotation differences were resolved in a consensus meeting and a final category was established for each report. Interannotator agreement was measured by accuracy and the kappa coefficient. RESULTS The prevalence of the three categories of actionable findings together was 32.5 %. Of all reports, 10.9 % were from patients seen in the emergency department. Prevalence of actionable findings for these patients (45.9 %) was considerably higher than for patients in routine clinical care (30.9 %). Interannotator agreement scores on the categorisation of actionable findings were 0.812 for accuracy and 0.616 for kappa coefficient. CONCLUSIONS The prevalence of actionable findings in radiology reports is high. The interannotator agreement scores are moderate, indicating that categorisation of actionable findings is a difficult task. To avoid unneeded increase in the workload of radiologists, in particular in routine practice, clinical context may need to be considered in deciding whether a finding is actionable.
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Affiliation(s)
- Jacob J Visser
- Department of Radiology and Nuclear Medicine, Erasmus MC, University Medical Center Rotterdam, Rotterdam, the Netherlands.
| | - Marianne de Vries
- Department of Radiology and Nuclear Medicine, Erasmus MC, University Medical Center Rotterdam, Rotterdam, the Netherlands.
| | - Jan A Kors
- Department of Medical Informatics, Erasmus MC, University Medical Center Rotterdam, Rotterdam, the Netherlands.
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15
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Possible solution for the problem of unread image interpretation reports: the “Gunma University Star Search”. Jpn J Radiol 2020; 38:643-648. [DOI: 10.1007/s11604-020-00944-2] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/26/2019] [Accepted: 02/29/2020] [Indexed: 12/26/2022]
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16
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Burns J, Gordon S, Scheinfeld M, Erdfarb A, Sprayragen S, Goldberg-Stein S. Use of a Macro as Nudge Factor in Communication Between Radiologists and Referring Physicians. Curr Probl Diagn Radiol 2020; 49:317-321. [PMID: 32276807 DOI: 10.1067/j.cpradiol.2020.02.002] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/24/2019] [Revised: 01/15/2020] [Accepted: 02/25/2020] [Indexed: 11/22/2022]
Abstract
INTRODUCTION/METHODS Radiologists provide value through communication of imaging findings. We outline a quality improvement effort using a dedicated dictation macro as a behavioral nudge to increase direct communication between radiologists and referring physicians. Use of the macro was encouraged by departmental leadership and publicised widely prior to implementation. Monthly data regarding the use of the macro and corresponding departmental volumes were acquired over a 24 month period. RESULTS Over the 24-month study period, there were 1,334,555 total exams performed and 52,276 total communications (3.90%; monthly range 2.21-4.67%). The greatest increase in adoption rate occurred during the initial 4-month period, with sustained rates of communication achieved after month 4. Results were more frequently communicated to a clinician when a resident trainee was involved in the dictation process. The greatest number of documented communications was for x-ray, followed by Computed Tomography (CT), Magnetic Resonance Imaging (MRI), Ultrasound (US), and nuclear medicine. Inpatient studies (7.23%) were communicated at a statistically significantly higher rate than Emergency Department (ED) (3.86%) or Outpatient (OP) studies (1.31%), P < 0.0001 for all comparisons. The rate of documented communication steadily increased across all patient classes. CONCLUSION Our findings demonstrate that simple interventions to increase the rate of documented communication can have durable results, and highlight the critical role radiologists play in timely and effective patient care delivery. Introduction of a communication macro coupled with departmental nudges resulted in increased direct communication of imaging results. This effort has promoted mutual engagement between radiologists and their colleagues, and demonstrates the active role of radiologists in direct imaging consultation.
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Affiliation(s)
- Judah Burns
- Department of Radiology, Montefiore Medical Center, Albert Einstein College of Medicine, Bronx, NY.
| | - Sharon Gordon
- Department of Radiology, Montefiore Medical Center, Albert Einstein College of Medicine, Bronx, NY
| | - Meir Scheinfeld
- Department of Radiology, Montefiore Medical Center, Albert Einstein College of Medicine, Bronx, NY
| | - Amichai Erdfarb
- Department of Radiology, Montefiore Medical Center, Albert Einstein College of Medicine, Bronx, NY
| | - Seymour Sprayragen
- Department of Radiology, Montefiore Medical Center, Albert Einstein College of Medicine, Bronx, NY
| | - Shlomit Goldberg-Stein
- Department of Radiology, Montefiore Medical Center, Albert Einstein College of Medicine, Bronx, NY
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17
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Simon AF, Holmes JH, Schwartz ES. Decreasing radiologist burnout through informatics-based solutions. Clin Imaging 2019; 59:167-171. [PMID: 31821974 DOI: 10.1016/j.clinimag.2019.10.014] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/18/2019] [Revised: 10/21/2019] [Accepted: 10/28/2019] [Indexed: 01/06/2023]
Abstract
Increased performance demands have interacted with suboptimal use of technology and contributed to burnout among radiologists. Although the problem of radiologist burnout has been well documented, there is a gap in the literature in terms of how technology can be better utilized to lessen the problem. Informatics-based modifications to existing technology hold the potential to reduce the amount of time radiologists spend on noninterpretive tasks, decrease interruptions, facilitate connections with colleagues, and improve patient care. Examples of successful modifications to technology are presented and discussed in relation to how they contribute to improving workplace engagement among radiologists.
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Affiliation(s)
- Andrew F Simon
- Department of Psychology, Seton Hall University, South Orange, NJ, United States of America
| | - John H Holmes
- Department of Biostatistics, Epidemiology and Informatics, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA, United States of America
| | - Erin Simon Schwartz
- Department of Radiology, Perelman School of Medicine, University of Pennsylvania, The Children's Hospital of Philadelphia, Philadelphia, PA, United States of America.
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18
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A Guided Survey Approach for Joint Commission Preparedness in Radiology. CURRENT RADIOLOGY REPORTS 2019. [DOI: 10.1007/s40134-019-0339-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/26/2022]
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19
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Waite S, Grigorian A, Alexander RG, Macknik SL, Carrasco M, Heeger DJ, Martinez-Conde S. Analysis of Perceptual Expertise in Radiology - Current Knowledge and a New Perspective. Front Hum Neurosci 2019; 13:213. [PMID: 31293407 PMCID: PMC6603246 DOI: 10.3389/fnhum.2019.00213] [Citation(s) in RCA: 49] [Impact Index Per Article: 9.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/18/2019] [Accepted: 06/07/2019] [Indexed: 12/14/2022] Open
Abstract
Radiologists rely principally on visual inspection to detect, describe, and classify findings in medical images. As most interpretive errors in radiology are perceptual in nature, understanding the path to radiologic expertise during image analysis is essential to educate future generations of radiologists. We review the perceptual tasks and challenges in radiologic diagnosis, discuss models of radiologic image perception, consider the application of perceptual learning methods in medical training, and suggest a new approach to understanding perceptional expertise. Specific principled enhancements to educational practices in radiology promise to deepen perceptual expertise among radiologists with the goal of improving training and reducing medical error.
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Affiliation(s)
- Stephen Waite
- Department of Radiology, SUNY Downstate Medical Center, Brooklyn, NY, United States
| | - Arkadij Grigorian
- Department of Radiology, SUNY Downstate Medical Center, Brooklyn, NY, United States
| | - Robert G. Alexander
- Department of Ophthalmology, SUNY Downstate Medical Center, Brooklyn, NY, United States
- Department of Neurology, SUNY Downstate Medical Center, Brooklyn, NY, United States
- Department of Physiology/Pharmacology, SUNY Downstate Medical Center, Brooklyn, NY, United States
| | - Stephen L. Macknik
- Department of Ophthalmology, SUNY Downstate Medical Center, Brooklyn, NY, United States
- Department of Neurology, SUNY Downstate Medical Center, Brooklyn, NY, United States
- Department of Physiology/Pharmacology, SUNY Downstate Medical Center, Brooklyn, NY, United States
| | - Marisa Carrasco
- Department of Psychology and Center for Neural Science, New York University, New York, NY, United States
| | - David J. Heeger
- Department of Psychology and Center for Neural Science, New York University, New York, NY, United States
| | - Susana Martinez-Conde
- Department of Ophthalmology, SUNY Downstate Medical Center, Brooklyn, NY, United States
- Department of Neurology, SUNY Downstate Medical Center, Brooklyn, NY, United States
- Department of Physiology/Pharmacology, SUNY Downstate Medical Center, Brooklyn, NY, United States
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Deckey DG, Eltorai AE, Jindal G, Daniels AH. Analysis of Malpractice Claims Involving Diagnostic and Interventional Neuroradiology. J Am Coll Radiol 2019; 16:764-769. [DOI: 10.1016/j.jacr.2018.10.022] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/21/2018] [Revised: 10/16/2018] [Accepted: 10/25/2018] [Indexed: 01/10/2023]
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21
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Lacson R, Babatunde V, Shinagare A, Khorasani R. Factors Impacting the Use of Terminology to Convey Diagnostic Certainty in Radiology Reports. Open Med Inform J 2018. [DOI: 10.2174/1874431101812010051] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
Abstract
Background:
Variable use of phrases expressing diagnostic uncertainty can lead to ambiguous radiology reports, a concern for information processing.
Objective:
This study aimed to quantify the usage of phrases conveying diagnostic certainty for abdominal imaging findings and assess factors that impact use of phrases with “good agreement” between radiologists and referring providers.
Methods:
This retrospective, Institutional Review Board-Approved study included all diagnostic reports generated by the Abdominal Radiology Division at an academic medical center July-September 2016. We assessed the use of 16 diagnostic certainty phrases using information retrieval from the Impression section of radiology reports. Phrases with good provider agreement for conveying the level of certainty are defined as “good agreement” phrases - including “diagnostic of”, “represents” and “unlikely.” We assessed the impact of imaging modality, trainee contribution to report generation, and individual radiologists.
Results:
In 5,598 radiology reports, 2,071 (37%) contained diagnostic certainty phrases, 119 (6%) of which were “good agreement” phrases. There was a significant difference between how frequently “good agreement” phrases were used in Magnetic Resonance Imaging (MRI), Computed Tomography (CT) and X-ray reports (p=0.0003). There was a significant variation among attending radiologists on the use of “good agreement” phrases (p<0.0019). There was no difference in the use of “good agreement” phrases in reports generated by attending radiologists alone compared to reports with trainees.
Conclusion:
Although phrases to convey diagnostic certainty were commonly used in radiology reports, the use of phrases with a good agreement was uncommon. Standardizing terminology to convey diagnostic certainty may reduce ambiguity in radiology reports and generate more accurate information processing tools.
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Freudenberg LS, Hicks RJ, Beyer T. An International Survey on Clinical Reporting of PET/CT Examinations: A Starting Point for Cross-Specialty Engagement. J Nucl Med 2018; 60:480-485. [PMID: 30389815 DOI: 10.2967/jnumed.118.218073] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/18/2018] [Accepted: 10/22/2018] [Indexed: 11/16/2022] Open
Abstract
Combined PET/CT imaging has become an integral part of patient management, particularly in oncology. After the imaging examination, a report of the findings is created by expert readers and sent to the referrers as a basis for subsequent decisions. In view of the known wide variation in operational models for PET/CT imaging, we surveyed PET/CT users on their approaches toward PET/CT reporting. Methods: The electronic survey comprised 28 questions on the demographics and professional background of the responders, as well as questions on the structure and quality of PET/CT reports, including the type of reported information, the use of reporting standards, and the mix of reporting standards and expert opinions. The survey was active for 6 wk in early 2018. In total, 242 responses were collected worldwide. Results: The responders were mainly from Europe (78%), with 22% being nuclear medicine specialists, 42% radiologists, 22% dual board-certified, 10% residents in either nuclear medicine or radiology, and 5% medical physicists, radiographers, or oncologists. A slim majority (55%) of responses indicated reports being done according to the European Association of Nuclear Medicine 2015 guidelines for 18F-FDG PET/CT imaging, but 30% of responders were unaware of these guidelines. Report structures varied across sites, with most sites (38%) reporting the PET findings with supplementary localization information from CT, whereas 27% of sites reported along the lines of a CT report with supplementary PET information. One third of the sites included information on the TNM stage of the oncology patient in all reports, whereas 34% and 12% of sites included this information occasionally or only for selected tumors, respectively. For therapy response assessment, various well-established criteria were used. The number of sites utilizing these criteria ranged from 15% (European Organisation for Research and Treatment of Cancer criteria) to 57% (Deauville criteria). Conclusion: Broad variation in the PET/CT reporting strategies adopted for oncology studies and widespread lack of awareness of existing guidelines for PET/CT reporting are evident from responses to this survey, raising concerns as to whether reporting clinicians are optimally using the complementary information from each modality. Greater efforts are needed to ensure harmonization of reporting practices.
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Affiliation(s)
| | - Rodney J Hicks
- Peter MacCallum Cancer Institute, Melbourne, Australia; and
| | - Thomas Beyer
- QIMP Group, Center of Medical Physics and Biomedical Engineering, Medical University Vienna, Vienna, Austria
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