How a large healthcare system reduced variation in radiology reports

A quality improvement project undertaken at a large academic medical center significantly reduced the variation in radiology report templates. The initiative may serve as an example of how radiology can move toward value-based care.

“In our practice, as at other large institutions, there was great variability in report structure among individual radiologists,” wrote Tony W. Trinh, MD, with the department of radiology at Brigham and Women’s Hospital in Boston, and colleagues. “Substantial differences in report structure, content, length, and degree of detail provided by different radiologists can be a source of confusion and frustration for referrers and patients.”

For example, Trinh et al. wrote, follow-up abdominal CT for a malignancy could be done in various sites: cancer imaging or abdominal imaging division, the emergency department or a community radiology site. Each had their own reporting template, which was further modified by trainees and attending physicians—a headache for everyone.

For the project, the researchers first performed a quality and safety initiative to standardize and optimize CT and MRI protocols across the system. An oversight committee was created to develop a standardized template structure; 24 work groups based on anatomy and modality made up the entire committee which met weekly for one hour between September 2017 and May 2018.

The team found 19,687 total templates at baseline. After the “harmonization process” there were 597 templates—a reduction of 97%. Trinh and colleagues did have to create 237 new templates for new protocols which bumped the net number of unique templates by 127 after their harmonization efforts. Radiologists continued to use the structured reporting templates nine months after the changes with usage rates from 88% to 100%, the authors wrote.

“As we move toward value-added radiology services, it is important that our reports be clear, succinct, organized, and easily comprehensible for referrers and patients,” the researchers wrote in the study, published Aug. 15 in the American Journal of Roentgenology. “Our harmonization initiative helped reduce this unwarranted variability.”

Reducing this fractured reporting presented a few other advantages, the authors explained. Templates can now be autopopulated with radiology codes once a specific exam is selected from the PACS, resulting in substantial time savings. The researchers also believe the project helped improve the overall content of radiology reports at their institution.

“Multifaceted interventions, including early involvement of stakeholders, a well-designed structure, a process to resolve potential conflicts, careful implementation to avoid disruptions in workflow, leadership engagement, and continuous monitoring, were the keys to successful implementation of this quality improvement project,” Trinh et al. wrote.