Critical radiology reports are meant to convey urgent findings to referring providers, but a new study published in PLOS One uncovers a breakdown of communication when flagging musculoskeletal reports in emergency departments.
Critical radiologic reports (CRRs) arise when a radiologist’s findings warrant extra attention from the referring provider. Improperly communicating these diagnostic errors or abnormalities may lead to potential legal and clinical ramifications for all involved.
“Critical or unexpected imaging findings with clinical significance may require timely non-routine communication,” corresponding author Yu Mi Jeong, with the Department of Radiology at Gil Medical Center in South Korea, and co-authors explained. “Radiologic reports with clinical significance or requiring immediate action should be promptly informed to the referring physician to ensure the continuity of patient treatment.”
Clinicians have little insight into how often critical reports emerge in musculoskeletal imaging, resulting in a limited understanding of potential issues. To get a better grasp of CRRs in the musculoskeletal space, researchers had two musculoskeletal radiologists retrospectively analyze 3,217 CRRs completed between January 2017 and December 2020.
Their findings were categorized by clinical setting (emergency department, inpatient, outpatient, etc.), body part, type of image modality, reason for CRR, incidental lesion and clinical outcome.
Out of all the reports, musculoskeletal CRRs accounted for only 5.4% (175), with most (94.9%) pertaining to the musculoskeletal system. Missed fractures occurred in 54.3%. More than half of the critical radiologic reports were for patients who presented to the emergency department (50.3%), followed by inpatients (30.9%).
When it came to communication, 80% of referring physicians actively acknowledged CRRs. However, the researchers noted a lack of follow-up action, particularly among ED patients. A 35.2% loss of follow-up care was observed in ED patients compared to 6.1% for outpatients and 3.7% for inpatients, prompting the experts to call for change.
“Physicians in the ED must pay more attention to CRRs, and radiologists should effectively communicate with the referring physicians and provide accurate and timely radiologic reports," the authors added. "A reliable standardized CRR manual is needed, and deployment is necessary across clinical practice."
In addition to her background in journalism, Hannah also has patient-facing experience in clinical settings, having spent more than 12 years working as a registered rad tech. She joined Innovate Healthcare in 2021 and has since put her unique expertise to use in her editorial role with Health Imaging.