Human + computer combination improves follow-through on radiology recommendations

Following a review of radiology reports and patient records that turned up glaring communications gaps over noncritical yet potentially serious findings, an urban academic medical center has invested in software and dedicated staff to close the gaps and cut the associated risks for harm.

The researchers behind the review describe the project in an article posted online Aug. 4 in the American Journal of Roentgenology.

Nadja Kadom, MD, Alexander Norbash, MD, and colleagues looked at 6,851 sets of reports and records generated over a 15-day period in 2014 at Boston University Medical Center, which is the largest safety-net hospital and level 1 trauma center in New England.

They found a total of 978 radiologist recommendations on noncritical findings from 857 reports (13 percent) containing any. The two most common recommendations were additional imaging (63 percent, n = 615) and clinical correlation (23 percent, n = 229).

Their key findings on communications gaps:

  • The majority of radiology recommendations were followed (67 percent, n = 655), but 323 cases (33 percent) contained no evidence that recommendations were followed.
  • Of those that were not followed, 39 percent (n = 126) had no documentation in the medical records of the recommendation being acknowledged.
  • Of those, 32 percent (n = 40) had important findings, half of which (n = 20) could have benefited from a verbal communication (18 mass lesions, two instances of fetal death).

The team also identified 18 potential cancer findings that were not acknowledged in the medical record.

Pro-active radiology department

In their discussion, Kadom and colleagues underscore that, in the group of 126 patients lacking evidence of action taken, 20 patients had reports suggesting they were ill or injured enough that morbidity and/or mortality were clear concerns—or should have been.

“We were unable to determine the exact outcomes in these patients or whether their care had truly lapsed,” they write, adding that it was quantifying the morbidity/mortality risk in these cases that led to the institution investing in a process-improvement intervention.

The radiology department generated a process map of result communication and potential for communication gaps, then presented it to the hospital’s quality and safety committee.

The consensus decision was to invest in some means of executing and documenting result notifications with an eye on consistency and actionability.

Solution: computer-human combo

After considering such solutions as automated pager notification, e-mail alerts and natural language processing software, they settled on—and the hospital is now using—a standardized, software-based approach for communicating noncritical results with ordering physicians.

The radiology department also created a new position for a “radiology-based human patient navigator” who tracks and follows up on noncritical recommendations that are not acted on or acknowledged, Kadom and colleagues report.

Further, BU Medical Center offers all its patients an online portal with access to radiology reports.

“As a safety-net hospital serving vulnerable populations, however, computer access or language barriers may prevent the portal use and limit the ability of this patient population to actively facilitate any recommended follow-up,” the authors write.

“Our effort resulted in a significant investment in both information technology solutions and radiology staff dedicated to communicating and tracking radiology recommendations and to minimizing the risk of patient harm,” the authors conclude. “Our findings and conclusions may serve as a point of reference for others who are seeking justification for financial investment into systems solutions.”