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Radiological outpatient' visits to avoid inappropriate cardiac CT examinations: an 8-year experience report. Radiol Med 2020; 126:214-220. [PMID: 32651776 DOI: 10.1007/s11547-020-01246-3] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/04/2020] [Accepted: 06/25/2020] [Indexed: 10/23/2022]
Abstract
PURPOSE The aim of this study was to evaluate the appropriateness of the cardiac computed tomography angiography (CCTA) prescriptions according to the "2010-Appropriate-Use-Criteria-for-Cardiac-Computed-Tomography-Angiography" (AUCCTA) and "Clinical-indication-for-CCTA" (CICCTA) among different specialities (Cardiologist [CA], General Practitioner [GP], Other Specialists [OS]) and prescribers' age. MATERIALS AND METHODS This is a single-centre, single-arm, cohort study. We prospectively enrolled 815 patients (October 2012-May 2019) who underwent a radiological outpatient visit, before CCTA examination. Prescriptions to the examination were categorized as follows: Appropriate (A), Uncertain (U) and Inappropriate (Ina), according to AUCCTA and I, II, III and Inv for CICCTA. This categorization was stratified according to CA, GP and OS and prescribers' age. CCTA was performed in patients whom indications belong to A/U categories. RESULTS Eight hundred and fifteen CCTA prescriptions were analysed. An yearly increase in prescriptions was found in the eight-year observational period (2012/2019 projection: 72 vs 223). Considering AUCCTA, indication A was 540/815 (66.3%), indication U was 113/815 (13.9%) and Ina accounted for 162/815 (19.9%; 128/162 [79.0%] indications with stress test listed as criterium of inappropriateness). Only U indications decreased over years (p = 0.003). Regarding CICCTA, 501/815 (61.5%) patients were categorized as I, 144/815 (17.7%) as II, 102/815 (12.5%) as III, 67/815 (8.2%) were INV and 1/815 (0.1%) were non-classified. Clinical referrals were CA in 495/786 (63.0%), GPs in 57/786 (7.3%) GP and OS in 234/786 (29.8%) [p < 0.01]. No statistically significant differences were observed in the appropriateness among different specialty physicians. Younger doctors have a lower chance to not meet A indication (OR 0.98 [CI 95% 0.96-0.99]; p = 0.003). CONCLUSION Our study highlights the importance of a pre-radiological visit prior to CCTA, which prevented execution of 19.9% of inappropriate examinations. Age of prescribers had an impact on appropriateness, with younger doctors having a lower chance to not meet A indication.
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Aggarwal A, Lazarow F, Anzai Y, Elsayed M, Ghobadi C, Dandan OA, Griffith B, Straus CM, Kadom N. Maximizing Value While Volumes are Increasing. Curr Probl Diagn Radiol 2020; 50:451-453. [PMID: 32222265 DOI: 10.1067/j.cpradiol.2020.02.011] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/14/2019] [Revised: 01/09/2020] [Accepted: 02/25/2020] [Indexed: 01/04/2023]
Abstract
Radiologists are facing ever increasing volumes while trying to provide value-based care. There are several drivers of increasing volumes: increasing population size, aging population, increased utilization, gaps in evidence-based care, changes in the provider workforce, defensive medicine, and increasing case complexity. Higher volumes result in increased cognitive and systemic errors and contribute to radiologist fatigue and burnout. We discuss several strategies for mitigating high volumes including abbreviated MRI protocols, 24/7 radiologist coverage, reading room assistants, and other strategies to tackle radiologist burnout.
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Affiliation(s)
| | - Frances Lazarow
- Department of Radiology, Eastern Virginia Medical School, Norfolk, VA
| | - Yoshimi Anzai
- Department of Radiology and Imaging Sciences, University of Utah School of Medicine, Salt Lake City, UT
| | - Mohammad Elsayed
- Department of Radiology and Imaging Sciences, Emory University School of Medicine, Atlanta, GA
| | - Comeron Ghobadi
- Department of Radiology, The University of Chicago Pritzker School of Medicine, Chicago, IL
| | - Omran Al Dandan
- Department of Radiology, Imam Abdulrahman Bin Faisal University College of Medicine, Dammam, Saudi Arabia
| | - Brent Griffith
- Department of Radiology, Henry Ford Health System, Detroit, MI
| | - Christopher M Straus
- Department of Radiology, The University of Chicago Pritzker School of Medicine, Chicago, IL
| | - Nadja Kadom
- Department of Radiology and Imaging Sciences, Emory University School of Medicine, Atlanta, GA
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Gillman J, Wu SE, Rowland J, Scanlon M, Chen PH. Comparison of In-Person and Digital Radiology Resident Consultation Services. J Am Coll Radiol 2019; 16:972-975. [DOI: 10.1016/j.jacr.2018.11.033] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/02/2018] [Revised: 11/09/2018] [Accepted: 11/22/2018] [Indexed: 11/15/2022]
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Affiliation(s)
- Jonathan B. Kruskal
- From the Department of Radiology, Beth Israel Deaconess Medical Center, Harvard Medical School, One Deaconess Rd, Boston, MA 02215 (J.B.K.); and Department of Radiology, Stanford University School of Medicine, Stanford, Calif (D.B.L.)
| | - David B. Larson
- From the Department of Radiology, Beth Israel Deaconess Medical Center, Harvard Medical School, One Deaconess Rd, Boston, MA 02215 (J.B.K.); and Department of Radiology, Stanford University School of Medicine, Stanford, Calif (D.B.L.)
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Conway SJ, Himmelrich S, Feeser SA, Flynn JA, Kravet SJ, Bailey J, Hebert LC, Donovan SH, Kachur SG, Brown PM, Baumgartner WA, Berkowitz SA. Strategic Review Process for an Accountable Care Organization and Emerging Accountable Care Best Practices. Popul Health Manag 2018; 21:357-365. [DOI: 10.1089/pop.2017.0149] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Affiliation(s)
| | | | | | - John A. Flynn
- Johns Hopkins School of Medicine, Baltimore, Maryland
| | | | | | | | - Susan H. Donovan
- Primary Care Coalition of Montgomery County Maryland, Silver Spring, Maryland
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Radiology Rounds in the Intensive Care Units Through a Telepresence Model. J Am Coll Radiol 2018; 15:1655-1657. [PMID: 30017628 DOI: 10.1016/j.jacr.2018.06.014] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/30/2018] [Revised: 06/12/2018] [Accepted: 06/13/2018] [Indexed: 11/23/2022]
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Snyder E, Solnes L, Horton KM, Johnson PT. Precision Radiology Residency Training: Special Distinction Tracks for Noninterpretative Professional Development. Acad Radiol 2018; 25:714-718. [PMID: 29751858 DOI: 10.1016/j.acra.2017.11.028] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/04/2017] [Revised: 11/19/2017] [Accepted: 11/22/2017] [Indexed: 11/28/2022]
Abstract
RATIONALE AND OBJECTIVES The role of a radiologist has expanded beyond the tripartite mission of patient care, education, and research to include cross-specialty consultation for patient management, innovative solutions to improve health-care quality and safety, device design, and policy advocacy. As such, radiology residency programs should incorporate formalized training to prepare residents for these various professional roles. MATERIALS AND METHODS Since the 2015-2016 academic year, five training tracks focused on noninterpretative skills have been integrated into our residency training program: Clinician Educator, Quality Improvement, Entrepreneurship/Innovation, Health Policy Advocacy, and High-Value Care. Each track is longitudinal, with a set of requirements throughout the residents' training necessary to achieve certification at graduation. RESULTS To date nine residents have participated in the programs, including two who received distinction in two separate tracks. Residents in each of the tracks have implemented successful initiatives related to the focus area. As such, these tracks enrich training by ensuring that residents make meaningful contributions to the department and institution during their training and disseminate successful initiatives through presentation at national meetings and publications. CONCLUSION The duration of a radiology residency and resources available in an academic center provide opportunities for residency program directors to advance residents' skills in important noninterpretative components of radiology practice. Regardless of whether residents pursue academic medicine or private practice, these skills are necessary for graduates to become valuable members of a radiology practice and serve as national leaders in the field of radiology.
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Affiliation(s)
- Elizabeth Snyder
- Department of Radiology, The Russell H. Morgan Department of Radiology and Radiological Science, Johns Hopkins School of Medicine, 1800 Orleans Street, Baltimore, MD 21287-0842
| | - Lilja Solnes
- Department of Radiology, The Russell H. Morgan Department of Radiology and Radiological Science, Johns Hopkins School of Medicine, 1800 Orleans Street, Baltimore, MD 21287-0842
| | - Karen M Horton
- Department of Radiology, The Russell H. Morgan Department of Radiology and Radiological Science, Johns Hopkins School of Medicine, 1800 Orleans Street, Baltimore, MD 21287-0842
| | - Pamela T Johnson
- Department of Radiology, The Russell H. Morgan Department of Radiology and Radiological Science, Johns Hopkins School of Medicine, 1800 Orleans Street, Baltimore, MD 21287-0842.
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Wildman-Tobriner B, Parente VM, Maxfield CM. Pediatric providers and radiology examinations: knowledge and comfort levels regarding ionizing radiation and potential complications of imaging. Pediatr Radiol 2017; 47:1730-1736. [PMID: 28852812 DOI: 10.1007/s00247-017-3969-8] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/04/2017] [Revised: 07/12/2017] [Accepted: 08/16/2017] [Indexed: 12/21/2022]
Abstract
BACKGROUND Pediatric providers should understand the basic risks of the diagnostic imaging tests they order and comfortably discuss those risks with parents. Appreciating providers' level of understanding is important to guide discussions and enhance relationships between radiologists and pediatric referrers. OBJECTIVE To assess pediatric provider knowledge of diagnostic imaging modalities that use ionizing radiation and to understand provider concerns about risks of imaging. MATERIALS AND METHODS A 6-question survey was sent via email to 390 pediatric providers (faculty, trainees and midlevel providers) from a single academic institution. A knowledge-based question asked providers to identify which radiology modalities use ionizing radiation. Subjective questions asked providers about discussions with parents, consultations with radiologists, and complications of imaging studies. RESULTS One hundred sixty-nine pediatric providers (43.3% response rate) completed the survey. Greater than 90% of responding providers correctly identified computed tomography (CT), fluoroscopy and radiography as modalities that use ionizing radiation, and ultrasound and magnetic resonance imaging (MRI) as modalities that do not. Fewer (66.9% correct, P<0.001) knew that nuclear medicine utilizes ionizing radiation. A majority of providers (82.2%) believed that discussions with radiologists regarding ionizing radiation were helpful, but 39.6% said they rarely had time to do so. Providers were more concerned with complications of sedation and cost than they were with radiation-induced cancer, renal failure or anaphylaxis. CONCLUSION Providers at our academic referral center have a high level of basic knowledge regarding modalities that use ionizing radiation, but they are less aware of ionizing radiation use in nuclear medicine studies. They find discussions with radiologists helpful and are concerned about complications of sedation and cost.
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Affiliation(s)
| | | | - Charles M Maxfield
- Department of Radiology, Duke University Hospital, 2301 Erwin Road, Durham, NC, 27710, USA
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Streamlining the Radiology Consultation Service in the Digital Era. J Am Coll Radiol 2017; 14:1464-1467. [DOI: 10.1016/j.jacr.2017.07.022] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/09/2017] [Revised: 07/04/2017] [Accepted: 07/10/2017] [Indexed: 11/20/2022]
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Alvin MD, Horton KM, Johnson PT. Training Radiology Residents to be Stewards in Healthcare Value. Acad Radiol 2017; 24:755-756. [PMID: 28238603 DOI: 10.1016/j.acra.2016.10.016] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/04/2016] [Accepted: 10/24/2016] [Indexed: 10/20/2022]
Abstract
Medical imaging procedures have become a national target in the campaign to reduce wasteful practices. At a minimum, radiology residency programs must integrate high-value curricula and train residents to practice in accordance with value-based principles and new healthcare policy. A greater portion of radiology resident education needs to be devoted to appropriateness education and consultancy training. Ideally, radiology training programs will instill in residents the importance of embracing the movement and leading the change.
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