Not so fast: Follow up lacking for additional imaging requests

Radiology reports that suggest further imaging are more likely to result in a lack of follow-up care than those without, according to a study published online Jan. 10 in the Journal of the American College of Radiology.

The authors, including Aymer Al-Mutairi, MD, with the Michael E. DeBakey Veterans Affairs Medical Center in Houston, noted that previous studies have shown that abnormal imaging results don’t necessarily lead to timely follow ups even when the ordering physician receives electronic alerts related to the results. Al-Mutairi and colleagues noted that lack of follow-up care potentially leads to suboptimal patient outcomes and could possibly be linked to malpractice claims.

“Radiology reports are the primary means of communication between a radiologist and the referring physician,” the authors wrote. Occasionally, reports contain ambiguous language that convey doubt or uncertainty in regards to the findings, often leading to lack of timely follow-up care.

Additionally, recommendations for additional testing require additional work on behalf of the ordering physician to investigate the problem further in the midst of their busy schedules.

“To examine these communication issues further, we tested the association between information contained in radiologists’ reports and follow-up outcomes,” Al-Mutairi and colleagues wrote. “We hypothesized that recommendations for further imaging, and expressions of doubt or uncertainty in the radiology report, are more likely to be associated with lack of timely follow-up.”

For the study, the researchers reviewed 250 outpatient radiology reports. Of these, 92 reports were not followed up in a timely manner. The remaining 158 reports did receive timely follow up and served as controls.

Doubt was identified with the terms “unable to exclude,” “cannot exclude,” “cannot rule out,” “possibly” or “unlikely” in the reports. The researchers also recorded the absence or presence of recommendations for further imaging in the reports.

Further imaging recommendations were made on 64.8 percent of all abnormal imaging studies and of these 75 percent did not receive timely follow-up care.

The team found expressions of doubt in equal proportions of radiology reports with and without timely follow up.

“We found that patients with abnormal imaging results for whom radiologists recommended further imaging were less likely to receive follow-up within 4 weeks, compared with patients without such recommendations,” Al-Mutairi and colleagues wrote.  “This finding underscores the potential need for developing additional safeguards that allow for better monitoring and tracking of patients with recommendations of further imaging to ensure appropriate follow-up actions.”