Rounding radiology residents improve patient care, referrer communication—and their specialty’s status

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 - Rounds

Members of a large academic radiology department have shown the value that resident-driven imaging rounds can add to patient care in a multidisciplinary care-delivery model. In the process, they’ve demonstrated a way the specialty can spotlight its contributions in the era of bundled payments and outcomes-oriented incentives.

Lead author Gayle Salama, MD, senior author Keith Hentel, MD, MS, and colleagues at New York-Presbyterian/Weill Cornell Medical Center describe their project in a study published online April 6 in Academic Radiology.

Twenty radiology residents and 150 internal-medicine physicians and medical students participated during the first 10 months of the resident-organized clinical imaging rounds (CIR) project, the authors report.

The rounds consisted of four 30-minute sessions held weekly with internal medicine services on inpatient wards. The referring service submitted case requests via email 24 hours before the scheduled CIR time, providing patient demographics, history and specific studies or findings for review.

“This lead time allowed the radiology resident to consult subspecialty attending radiologists with any questions before meeting with the medicine teams,” the authors note, adding that CIR were structured with the medicine team presenting the relevant patient history.

The radiology residents used the hospital’s PACS to highlight relevant imaging findings, take imaging-related questions and discuss case-management options.

After the completion of the 10-month study period, the researchers surveyed participants on their perceptions and impressions of the CIR.

Most of the radiology resident participants (85 percent) completed survey, as did almost a third of the internal-medicine participants (n = 45).  

“There was an overwhelming positive review of imaging rounds, with a large majority of all groups agreeing that imaging rounds improve education, communication and patient care,” the authors write.  

Key findings bearing out this assessment include:

  • 84 percent of medicine and 88.2 percent of radiology participants believed the CIR improved patient care.
  • 100 percent of internal medicine attending physicians responded that CIR improves patient care.
  • 93.2 percent of medicine providers and 94.1 percent of radiology trainees felt CIR allowed the radiologist to have a better understanding of the patient, resulting in a more complete assessment and interpretation.
  • 70.5 percent of medicine respondents and 75 percent of radiology residents said CIR affects the clinical management of patients.
  • 69 percent of medicine teams and 88.2 percent of radiology residents respond that CIR improved their skills as a consultant.

Among the study limitations the authors cite are its use of a single referrer specialty and possible self-selection bias by respondents positively inclined toward the project.

Also, the focus of CIR is the patient—yet no patients were involved. The authors acknowledge this lack and look ahead to future studies.

“The next phase of CIR will include reviewing imaging results directly with patients and their families at the bedside,” Salama et al. write in their discussion. “This is another opportunity to demonstrate radiology’s added value.”

As pay-for-performance reimbursement models increase in prevalence, they add, radiologists “must continue to explore and implement new ways to add value to the medical system.”

The authors express their intentions to incorporate a user-friendly, tablet-compatible image viewer to facilitate discussions with physician colleagues and patients at the bedside.