Communicating abnormal findings to clinicians may not ensure follow-up

CHICAGO - Directly communicating abnormal findings and follow-up recommendations to clinicians does not guarantee they will always follow through with additional imaging studies, according to research presented at the 2007 RSNA meeting.

"Direct communication, even with a verified and validated double-check protocol, does not necessarily ensure that there is follow-through with (the) recommendations," said Dr. Amy Musk from the VA Maryland Medical Center in Baltimore. She presented the study team's findings Wednesday morning during a scientific session.

The group sought to determine how often abnormal findings were not followed up, which imaging modalities and hospital services were most often involved, and, if possible, to determine the reasons for the lack of follow-up.

The researchers retrospectively reviewed a database of recommendations by staff radiologists for radiological follow-up from all imaging modalities between September 2005 and December 2006. The institution's standard protocol is to refer all significant positive findings directly to the referring physician by either the administrators or the radiologists themselves, Musk said. These communication encounters are recorded in the electronic medical records (EMR) system.

Patients with no evidence of imaging follow-up in response to oral and written communication of abnormal findings were identified and included in the study. Of the 56,083 total studies performed during the study period, 1,650 (2.9%) had an abnormal imaging report.

Of these, 153 (9.3%) had no evidence of imaging follow-up, even after multiple communication attempts, Musk said. In looking at the data by department, the emergency department contributed the most of these cases, followed by managed care and then both the surgical and medical clinics.

In a breakdown by abnormal findings per modality, plain film contributed 82.3%, while nuclear medicine contributed 9.2%. CT, ultrasound, MRI, and fluoroscopy made up 3.9%, 2.6%, 1.3%, and 0.7%, respectively.

The researchers identified numerous factors for why studies are not followed up, including the possibility of missing relevant clinical history, patient wishes/ beliefs about his or her healthcare not included in the chart, as well as all the additional workup performed at an outside hospital.

The team also noted numerous pitfalls found in the chain of communication, some of which are unique to an academic hospital. This includes the frequent change in primary coverage of a patient's care, as well as overreads of radiology residents' preliminary reports by attendings, Musk said.

Inadequate patient history or missing lab results could be found in all hospitals, however, she said.

"Perhaps an automated tracking system will not only allow for audit of communication and receipt of findings, but also close that loop in patient management," Musk said.

By Erik L. Ridley staff writer
November 28, 2007

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Copyright © 2007

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