Radiology requisitions are getting longer, but quality clinical information is declining

Radiologist requisitions are the primary means of acquiring clinical information and have been shown to improve diagnosis. But new research suggests the quality of clinical information in these forms is declining, according to an April 12 study in Academic Radiology.

In this research, a University of Chicago team analyzed three categories of imaging studies: chest x-rays, abdomen/pelvis CTs and head CTs. Content quality was measured on an established scale relating to four categories: signs and symptoms, medical history, abnormal test results and clinical questions.

There was a “statistically significant” decline in the quality of clinical questions in all CTs rated and a decline in the quality of medical histories received in requisitions for chest x-rays, according to corresponding author, Travis B. Wassermann, with the Pritzker School of Medicine and colleague.

“The quality of clinical information contained in radiology requisitions is decreasing over time independent of systemic changes, which is concerning because a lack of clinical information can impact the value that medical imaging adds to patient care,” Wassermann et al. wrote.

In the same research, the pair analyzed 13 study types, nine had more than 1,000 total requisitions. Of those nine, six showed an increased character length trend. Four showed an increasing proportion of identical answers to the questions “signs and symptoms” and “clinical questions to be answered.”

Authors proposed the similarity in characters may suggest “many clinicians are simply copying and pasting information from one box to the next rather than individually attempting to answer both questions.”

Wassermann et al. noted the trend in lengthening requisitions was “unexpected,” and suggested providers may be coming more comfortable with computerized ordering systems.

The real concern for the authors was the declining quality of clinical information, which they attributed to either increasing time demands on clinicians or shifting attitudes in radiology.

“Medical educators and hospital administrators should be aware that without concerted efforts to improve the quality of information provided to radiologists in requisitions, it may continue to decline, which may hamper the ability of radiologists to optimally contribute to patient care,” Wassermann et al. noted.