Practice guidelines: the radiology perspective

A Call to Improve the Visibility and Access of the American College of Radiology Practice Parameters in Neuroradiology: A Powerful Value Stream Enhancer for Both Neuroradiologists and Patients

Clinical practice guidelines and clinical practice parameters are among the tools that clinicians and radiologists use to inform decision making in the diagnosis and treatment of patients. Radiologists have been urged to objectively establish their value and measurable contributions to patient care. Radiology's contribution to the health care value stream can be established in the development of sound clinical practice guidelines. Neuroradiologists have been quite active in developing clinical guidelines, particularly in collaboration with the American College of Radiology, but there is a need to increase the visibility and accessibility of such documents. Increasing access and visibility can contribute to improved patient outcomes and an improved overall quality of care.

Barriers and facilitators for guideline adherence in diagnostic imaging: an explorative study of GPs' and radiologists' perspectives

Background

Diagnostic imaging has been a part of medicine for the last century. It has been difficult to implement guidelines in this field, and unwarranted imaging has been a frequent problem. Some work has been done to explain these phenomena separately. Identifying the barriers to and facilitators of guideline use has been one strategy. The aim of this study is to offer a more comprehensive explanation of deviations from the guideline by studying the two phenomena together.

Methods

Eight general practitioners and 10 radiologists from two counties in Norway agreed to semi-structured interviews. Topics covered in the interviews were knowledge of the guideline, barriers to and facilitators of guideline use, implementation of guidelines and factors that influence unwarranted imaging.

Results

Several barriers to and facilitators of guideline use were identified. Among these are lack of time, pressure from patients, and guidelines being too long, rigid or unclear. Facilitators of guideline use were easy accessibility and having the guidelines adapted to the target group. Some of the factors that influence unwarranted imaging are lack of time, pressure from patients and availability of imaging services.

Conclusion

There are similarities between the perceived barriers for guideline adherence and the perceived factors that influence unwarranted imaging. There may be a few reasons that explains the deviation from guidelines, and the amount of unwarranted imaging.

Electronic supplementary material

The online version of this article (10.1186/s12913-018-3372-7) contains supplementary material, which is available to authorized users.

The concept of error and malpractice in radiology

Since the early 1970s, physicians have been subjected to an increasing number of medical malpractice claims. Radiology is one of the specialties most liable to claims of medical negligence. The etiology of radiological error is multifactorial. Errors fall into recurrent patterns. Errors arise from poor technique, failures of perception, lack of knowledge, and misjudgments. Every radiologist should understand the sources of error in diagnostic radiology as well as the elements of negligence that form the basis of malpractice litigation. Errors are an inevitable part of human life, and every health professional has made mistakes. To improve patient safety and reduce the risk from harm, we must accept that some errors are inevitable during the delivery of health care. We must play a cultural change in medicine, wherein errors are actively sought, openly discussed, and aggressively addressed.

Malpractice issues and contrast use

As the cost of nonionic lower-osmolality contrast media decreases, the standard of practice for using such agents changes, and the implications of informed consent increase. Failure to use specific contrast agents appropriately or failure to respond correctly to a contrast reaction can lead to the claim of malpractice. These topics are reviewed in the context of current practice guidelines.

On-call radiology: community standards and current trends

The issues regarding on-call radiology are complex and contentious. Both academic and private practice radiology centers have encountered increasing workloads in recent years. Some academic centers are utilizing night float systems or other models of call to address the increasing complexity and volume of after-hours cases. Many private practice groups are outsourcing after-hours work to commercial nighthawk radiology services. Emergency medicine department and ACR guidelines place additional expectations on the on-call radiologist.

Breast imaging, standard of care, and the expert

Many radiologists have the opportunity to serve as experts in determining whether a colleague's actions are within standard of care. This is an important responsibility because, in large part, the fairness and success of the judicial system determining whether medical negligence has occurred is dependent on the opinion of the medical expert. Especially in the field of breast imaging, the physician acting as an expert often has to base opinions on judgments rather than incontestable facts. To make judgments of the highest quality, the expert must possess a clear understanding of the concept of standard of care. This article focuses on the role of experts in malpractice cases dealing with mammography and the delay of diagnosis of breast cancer.