RSNA: ED docs need face time with rads (Part 3 of 4)

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CHICAGO—Radiologists and emergency department (ED) physicians can improve their sometimes rocky relationships with personal communication and concise, rapid fire results, according to the What the Referring Physician Needs to Know session presented Nov. 28 at the 96th annual scientific meeting of the Radiological Society of North America (RSNA).

Health Imaging News will share referring physicians’ wish lists in a four-part series during RSNA week. Part 3 details emergency physicians’ needs.

Moderated by Mary C. Mahoney, MD, director of breast imaging at University of Cincinnati in Ohio, the four-part session queried a variety of physicians to help radiologists better understand how to meet their needs. Mahoney asked the four physicians to respond to five questions:

  • What information do you like to see in radiology reports?
  • How do you want important results communicated to you?
  • Would you like radiologists to speak to patients about clinical findings (or lack thereof) on an imaging exam?
  • How do you figure out the correct imaging exam?
  • Do you know about American College of Radiology (ACR) Appropriateness Criteria?

The emergency room physician perspective

The relationship between radiology and emergency departments is a work a progress. Face to face communication can help, offered Jeffrey G. Graff, MD, head of emergency medicine at NorthShore University Health System in Chicago. Systems such as PACS and RIS have impeded communication, stated Graff, who added that he addresses this issue with regular visits to the radiology department.

The ED chief posed that radiology has created a monster in the form of advanced imaging modalities.

“Now, that monster has to be fed. It’s made radiologists more necessary.” ED physicians need radiologists for assistance in the problem-solving process; however, time is critical. “We need answers in a contemporaneous fashion.”

ED physicians need concise answers. “I want an answer to question I’m asking—not all the details. I don’t need to know about 3 mm nodule that needs a follow-up CT in six months,” explained Graff. The ED should be spared incidental findings, extraneous verbiage and suggestions for more tests in the report. Most results should be communicated in the EMR, but cases that truly require additional immediate testing merit a phone call.

Graff narrowed the ED wish list to seven Cs:

  • Contemporaneous;
  • Consultation;
  • Collegiality;
  • Collaboration;
  • Cooperation;
  • Clarity; and
  • Customer service.

In challenging imaging cases, Graff consults with friendly radiologists (think relationship-building) to determine what tests to order and also asks his radiologist colleagues if there are other studies that might be recommended. He acknowledged the intense pressure on ED physicians to limit CT scans and admitted that most residents will “scan anyone with a pulse.”

He was less certain of the utility ACR Appropriateness Criteria for ED physicians. “I had never heard of it. It was fascinating but not very useful for what I do. All these criteria look at populations not individual patients. I look at patients and make informed decision based on patients.

Ultimately, Graff urged radiologists to remember--I’m your customer, you are my customer, but the patient is our customer.