The Use of an Emergency Department Expeditor to Improve Emergency Department CT Workflow: Initial Experiences

To Operate or Not? Balancing Advanced Imaging, Machine Learning, and the Doctor-Patient Relationship in Complex Clinical Decision Making

Advances in high-resolution, cross-sectional imaging have changed the practice of medicine. These innovations have clearly benefited patient care yet have also led to a decreased dependence on the art of medicine, with its emphasis on obtaining a thoughtful history and thorough physical examination to elicit the same diagnosis that imaging provides. What remains to be determined is how physicians can balance these technological advances with their own ability to use clinical experience and judgment. This can be seen not only with the use of high-level imaging but also with the increasing use of machine-learning models throughout medicine. The authors contend that these should be seen not as a replacement for the physician, but as another tool in their arsenal in determining management decisions. These issues are salient for surgeons, who, given the serious undertaking required to operate on a person, must develop trust-based relationship with their patients. Navigating this new field brings with it several ethical conundrums that must be addressed, with the final goal being to provide optimal patient care without sacrificing the human element involved, from either the physician or the patient. The authors examine these less-than-simple challenges, which will continue to develop as physicians use the increasing amount of machine-based knowledge available to them.

Use of a Macro as Nudge Factor in Communication Between Radiologists and Referring Physicians

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.