BMC: Over-investigation, poor referrals lead to hospital over-imaging

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Researchers polled 374 radiologists about their perspectives on the causes of increasing and unnecessary use of radiological investigations, the results of which were published Sept. 1 in BMC Health Services Research.

Kristin B. Lysdahl and Bjørn M. Hofmann, PhD, from the University of Oslo in Norway, sent a questionnaire to radiologist members of the Norwegian Medical Association, asking them about potential causes of increased investigation volume and unnecessary investigations. The response rate was 70 percent.

Overall, the five highest scored causes of increased use were: increased possibilities due to new radiological technology; patients' increased demands for certain knowledge about their own health; referring physicians' lower tolerance for uncertainty; expanded clinical indications for radiology; and increased availability of radiological equipment and personnel.

Radiologists in hospital settings responded that the following reasons influenced the cause of unnecessary radiological investigations to a large or very large extent:

  • Repeating investigations: 10 percent;
  • Anticipated results unlikely to affect patient management: 30 percent;
  • Investigating too often: 29 percent;
  • Doing the wrong investigation: 3 percent;
  • Insufficient referral information: 44 percent; and
  • Over-investigation: 50 percent.

Those radiologists employed at private radiology facilities also named over-investigation (33 percent) and insufficient referral information (26 percent) as the top reasons for unnecessary radiological investigations.

“Over-utilization implies wasteful investigations, such as those whose results are unlikely to affect patient management. Because some investigations carry risks from radiation exposure and many can be expensive to the health service, it is important to limit their excessive use," Lysdahl said.

The authors also noted that patients have “become better informed about their rights, and they appear increasingly demanding of investigative procedures."

To manage the growth in radiological imaging and curtail inappropriate investigations, Lysdahl and Hofmann said the study findings point to measures that influence the supply and demand of services, specifically to support the decision-making process of physicians.