Health information technology is developing at a rapid pace, and with it the expectation for radiologists to review and report findings post haste. In addition, many policy and reporting changes are further increasing demands on both clinicians and radiologists, which can make the communication of critical test results difficult to manage. The resulting danger is a breakdown in communication that threatens the quality of care we are able to provide to our patients.
It seems as though these policies have caught healthcare professionals in a double-bind: we have sworn an oath to always keep our patients’ health first and foremost, yet we are required by law to adhere to new regulatory reporting that is forcing us to divert our attention and time away from those for whom we care. And my guess is that if you asked any clinician to prioritize responsibilities, he or she would quickly choose the former over the latter. This tension can be seen all over the healthcare field, but is particularly noticeable with the lines of communication between radiologists and physicians.
A study published in American Journal of Roentgenology found that typically, primary care physicians receive more than 40 radiologic reports each week. Of those physicians, 83 percent of them reported delays in the receipt of test results and only 41 percent were satisfied with how the test results are managed. Providing this simple snapshot of workloads in context of our own hospital, which has the fifth highest Emergency Department (ED) volume in the country, helped establish the importance of bridging this communication gap.
In order to ensure our patients were receiving the timeliest treatment, we’ve worked with our clinical teams to define the criteria that would be used for both critical and unexpected findings and timeframes associated with each. For instance, we decided that compliance goals for critical results need to be communicated within 60 minutes after initial contact and unexpected results needed to be communicated within 24 hours after initial contact. By establishing these standards and enforcing them, we have been able to ensure that important findings are always shared with the right clinical teams and attending physicians.
Since implementing this streamlined approach to the communication of critical results, we surveyed our physicians to determine the success of the program. Results show that 74 percent liked the system, and those who did not like the system cited the lack of direct communication with radiologists as their main reason. The implementation, however, was not without some lessons learned, including:
- Preserve dialogue: All efforts should be made to contact the physician directly prior to using the system to communicate results. We found that our physicians still prefer to speak directly to a radiologist. The collaborative benefits of discussing a patient’s health are an invaluable part of practicing medicine.
- Customize to make it work: Tailor the CTRM system for doctors based on their workflows (for instance, gastroenterology or genitourinary). Technology needs to work for people, not the other way around. Taking the time to evaluate clinical teams’ needs and creating a system that accommodates these requirements will not only make the adoption easier, it will streamline workflows down the line.
- Know when to pick up the phone: Not all patients are equal, if the individual is still in the ED, radiologists should directly call the ED physician. Creating a policy for this type of situation ensures that important findings can be discussed immediately, resulting in improved quality of care.
- Utilize the collaborative features: Often, the best decisions are made after getting different perspectives from colleagues. Using the “cc” function to include other attending physicians or specialists can lead to insights on patient treatment options.
- Measure results: Capturing data for metrics such as direct conversations is important for tracking key performance indicators.
Although health technology can be unwieldy at times, it also contains the ability to provide even better care to our patients. Faster communication of radiological results means faster diagnosis and treatment plans—and those are quality indicators that save lives in a new era of value-based care.
Dr. Flyer will be presenting at the RSNA session, “Taking the Hunting and Gathering Out of Radiology with Intelligent Personal Assistants,” on Tuesday, December 3 at 3:00 p.m. in room S402AB.