JOURNAL CLUB: Informal Consultations Between Radiologists and Referring Physicians, as Identified Through an Electronic Medical Record Search

The Value of Radiology Consultation: Effort Allocation, Clinical Impact, and Untapped Opportunities

A substantial proportion of work in radiology involves activities beyond the primary interpretation of imaging. In this review, the authors discuss the current state of consultative work in radiology and evaluate potential strategies for more equitable reimbursement of these activities. "Noninterpretive" or "consultative" activities may constitute 35% to 60% of work hours. These activities routinely impact patient care; for example, changes in management are seen with 3-9% of radiologist-protocoled exams, 8-37% of secondary interpretations, 12-55% of ad-hoc ("curbside") consultations, and 8-58% of multidisciplinary conferences. Currently, ad hoc and multidisciplinary consultations are not associated with formal mechanisms for documentation or billing, despite together constituting 10% to 15% of radiologists' work hours. Existing and future mechanisms, however, could help bridge this gap. Practice in radiology might benefit from dedicated consultation Current Procedural Terminology billing codes, similar to those already in place for consultations in pathology. Existing non-face-to-face (electronic) consultation codes represent a potential stopgap solution. Practices may alternatively negotiate compensation for noninterpretive tasks as part of a value-based reimbursement model. Any viable solution would need to account for the opportunity cost of time spent on nonbillable activities (usually >5 work relative value units/hour). Consultation is likely to play an increasingly important role in the future of radiology with advances in imaging and artificial intelligence-based technologies. Individual radiologists and group practices would benefit from recognizing and leveraging the value of their consultative work.

Digitalised multidisciplinary conferences effectively identify and prevent imaging-related medical error in intensive care patients during the COVID-19 pandemic

This study aims to assess the effectiveness of digital multidisciplinary conferences (MDCs) in preventing imaging-related quality management (QM) events during the coronavirus-disease-19 (COVID-19) pandemic. COVID-19 challenged interdisciplinary exchange and QM measures for patient safety. Regular MDCs between radiologists and intensive care unit (ICU) physicians, introduced in our hospital in 2018, enable re-evaluation of imaging examinations and bilateral feedback. MDC protocols from 2020 to 2021 were analysed regarding imaging-related QM events. Epidemiological data on COVID-19 were matched with MDCs. 333 MDCs including 1324 radiological examinations in 857 patients (median age = 64 (IQR = 55-73) years, 66.7% male) were analysed. MDCs were held within a median of 1 day after imaging (IQR = 1-3). QM events were identified in 2.7% (n = 36/1324) of examinations. This represented a significant decrease compared to a control group from 2018/2019 (QM events identified in 14.0%, p < 0.001). QM incidence remained consistent in the pandemic cohort (regression coefficient estimate = -0.01, 95% confidence interval = [0.000, 0.000], p = 0.68). 81% (n = 29/36) of QM events were report-related, 19% process-related (n = 6/36), and 2.8% indication-related (n = 1/36). In 7.3% (n = 97/1324) of examinations, the patient was affected by COVID-19. With MDCs as an effective feedback mechanism in place, the challenges of the COVID-19 pandemic led to no increase in QM incidence. Notably, COVID status did not impact QM event occurrence.

Interdepartmental miscommunication regarding radiology: Addressing chronic challenges and exploring solutions

Effective communication and collaboration among healthcare professionals are crucial for delivering high-quality patient care. Interdepartmental miscommunication poses a significant challenge to healthcare systems, potentially undermining the quality of healthcare services provided. In the same manner, communication barriers between referring physicians and radiologists can specifically affect radiology services and patient outcomes. This article attempts to put the spotlight on the ever-present chronic challenges of this issue and prompt readers to recognize the relevant potential pitfalls in their daily clinical practice. Practical solutions are explored and proposed, which should be tailored to the specific needs and issues that each individual institution may face.

The Virtual Radiology Reading Room: Initial Perceptions of Referring Providers and Radiologists

The objective of this study is to assess the initial perception of referring providers and radiologists to a virtual consultation solution (the Virtual Radiology Reading Room, VR3). VR3 is specifically designed to replace the radiology reading room phone and enable the radiologist to continue to work as part of the clinical care team fielding radiology consults without being confined to the same physical space. Surveys of providers' and radiologists' initial experience were conducted approximately 6 months after initial deployment. Users were asked about their overall impression, and how well the solution integrates with their workflow as well as how it compares to traditional phone calls to the reading room. Forty of 71 referring providers and 27 of 44 radiologists responded to our survey. VR3 was rated 4.7 out of 5 stars by referrers and 4.1 by radiologists. Seventy percent of referrers and radiologists preferred VR3 to the phone while 4.5% of referrers and 11% of radiologists preferred the phone. Referring providers and radiologists expressed a positive initial perception of the Virtual Radiology Reading Room and prefer it to traditional phone calls to the reading room.

Imaging intensive care patients: multidisciplinary conferences as a quality improvement initiative to reduce medical error

Background

Strategies to identify imaging-related error and minimise its consequences are important in the management of critically ill patients. A new quality management (QM) initiative for radiological examinations has been implemented in an intensive care unit (ICU) setting. In regular multidisciplinary conferences (MDCs), radiologists and ICU physicians re-evaluate recent examinations. Structured bilateral feedback is provided to identify errors early. This study aims at investigating its impact on the occurrence of QM events (imaging-related errors). Standardised protocols of all MDCs from 1st of June 2018 through 31st of December 2019 were analysed with regard to categories of QM events (i.e. indication, procedure, report) and resulting consequences.

Results

We analysed 241 MDCs with a total of 973 examinations. 14.0% (n = 136/973) of examinations were affected by QM events. The majority of events were report-related (76.3%, n = 106/139, e.g. misinterpreted finding), followed by procedure-related (18.0%, n = 25/139, e.g. technical issue) and indication-related events (5.8%, n = 8/139, e.g. faulty indication). The median time until identification of a QM event (time to MDC) was 2 days (interquartile range = 2). Comparing the first to the second half of the intervention period, the incidence of QM events decreased significantly from 22.9% (n = 109/476) to 6.0% (n = 30/497) (p < 0.0001). Significance of this effect was confirmed by linear regression (p < 0.0001).

Conclusions

Establishing structured discussion and feedback between radiologists and intensive care physicians in the form of MDCs is associated with a statistically significant reduction in QM events. These results indicate that MDCs may be one suitable approach to timely identify imaging-related error.

Supplementary Information

The online version contains supplementary material available at 10.1186/s13244-022-01313-5.

The Radiology Virtual Reading Room: During and Beyond the COVID-19 Pandemic

The COVID-19 pandemic has disrupted the radiology reading room with a potentially lasting impact. This disruption could introduce the risk of obviating the need for the reading room, which would be detrimental to many of the roles of radiology that occur in and around the reading room. This disruption could also create the opportunity for accelerated evolution of the reading room to meet the strategic needs of radiology and health care through thoughtful re-design of the virtual reading room. In this article, we overview the impact of the COVID-19 pandemic on radiology in our institution and across the country, specifically on the dynamics of the radiology reading room. We introduce the concept of the virtual reading room, which is a redesigned alternative to the physical reading room that can serve the diverse needs of radiology and healthcare during and beyond the pandemic.

Difficulties and possibilities in communication between referring clinicians and radiologists: perspective of clinicians

Purpose

To investigate modes and quality of interprofessional communication between clinicians and radiologists, and to identify difficulties and possibilities in this context, as experienced by referring clinicians.

Patients and methods

Focus group interviews with 22 clinicians from different specialties were carried out. The leading question was: "How do you experience communication, verbal and nonverbal, between referring clinicians and radiologists?" Content analysis was used for interpretation of data.

Results

Overall, referring clinicians expressed satisfaction with their interprofessional communication with radiologists, and digital access to image data was highly appreciated. However, increased reliance on digital communication has led to reduced face-to-face contacts between clinicians and radiologists. This seems to constitute a potential threat to bilateral feedback, joint educational opportunities, and interprofessional development. Cumbersome medical information software systems, time constraints, shortage of staff, reliance on teleradiology, and lack of uniform format of radiology reports were mentioned as problematic. Further implementation of structured reporting was considered beneficial.

Conclusion

Deepened face-to-face contacts between clinicians and radiologists were considered prerequisites for mutual understanding, deepened competence and mutual trust; a key factor in interprofessional communication. Clinicians and radiologists should come together in order to secure bilateral feedback and obtain deepened knowledge of the specific needs of subspecialized clinicians.