Reality Check: Optimizing Electronic and Human Interactions in Radiology

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The need for improving communications in radiology is well understood, but optimizing interactions with referring physicians is where it gets tricky. In a 772-bed tertiary-care teaching hospital and level I trauma center, the call for increased face time must be balanced, supported, and made optimal through the smart use of electronic tools.

At Einstein Medical Center, Philadelphia, Pennsylvania, where Terence Matalon, MD, FACR, FSIR, is chair of the radiology department, multiple strategies are used to give referrers the information they need, in the format they prefer, in an appropriate time frame.

Terence Matalon“Communication is a critical part of the work product of the radiologist. It’s not simply our job to interpret the images, but to ensure that the study that is being done is actually the correct exam, and that the message that we are trying to deliver is actually delivered to the appropriate person.”

—Terence Matalon, MD, FACR, FSIR

 

The 24-radiologist department reads about 280,000 exams annually—a figure that will jump to 350,000 in September, when the Einstein Healthcare Network (EHN) absorbs a smaller community hospital. Department radiologists currently interact with approximately 600 employed staff physicians and at least another 600 community physicians.

At the center of EHN radiology communications is an electronic system for communicating critical and significant results that has been optimized by referrer and for severity. Other key communications strategies include a movement toward using report templates, participation in hospital committees, and various initiatives by which radiologists insert themselves in the diagnostic evaluation of the patient.

The Nerve Center

While many sites use three levels of acuteness to comply with Joint Commission requirements for critical-results communications, Matalon and his team chose to proceed with two levels: emergency-level results that must be communicated within one hour and significant results that must be communicated within three days. Last month, the team communicated approximately 600 significant results and 40 emergency-level results.

“We felt there was some simplicity in distinguishing between something that needed to be done right away versus something that could be communicated within three days,” Matalon explains. “Based on that criterion as a function of our Joint Commission requirement to monitor compliance, we have about a 98% compliance rate for significant messages (because the leeway there is pretty long, at three days), and we have about a 70% or so compliance rate for emergency-level messages.”

Not only is the communication of important results a regulatory issue, but it also is a crucible in malpractice defense. “If one looks at malpractice suits that involve radiologists, communication is a very frequent theme as the underlying root cause for the suit,” Matalon emphasizes. “Historically, its been reported to be a central issue in 30% to 40% of malpractice cases, so its unlikely that people overcommunicate findings.”

Nonetheless, determining whether a finding should be communicated is up to the discretion of the radiologist, and knowing when and how to intrude into another physician’s workflow is an important call.

“I hope that they would not bother somebody for something that is already a known fact,” Matalon says. “If there is pneumothorax that is well known, and we are just monitoring a chest radiograph, over time, that shows a static, nonchanging pneumothorax, unless there is a dramatic decrease or increase in that pneumothorax, there would be no reason to reach out to the clinician to let him or her know that there was a pneumothorax there. If the pneumothorax became larger, though, that might warrant a change in the management and therapy of the patient—and it would be significant.”

The Right Touch

Not all physicians are communicated with in the same way, and the primary differences are seen for two classes of physicians at Einstein Medical Center: emergency physicians and trauma surgeons in the emergency department, who almost always receive a phone call that is then documented within the critical-results–communication system used at Einstein Medical Center.

A significant finding, on the other hand, is one that could affect the patient’s treatment. “It doesn’t necessarily have to be a critical result, and it doesn’t have to be a life-threatening result, but it might have an impact on a decision to change or institute