Virtual morning rounds encourage collaboration between radiologists, other providers
An immersive video conference between radiologists and ICU clinicians could facilitate relationships between doctors who haven’t been connected for a decade and boost quality of care in both departments, a group of Philadelphia physicians reported this summer in the Journal of the American College of Radiology (JACR).
“Since the advent of PACS, interaction between radiologists and caregivers has diminished,” first author Jonathan Zember, MD, and colleagues at the Children’s Hospital of Philadelphia, said in JACR. Those relationships, once sustained by daily film reviews of imaging cases—or “radiology rounds”—have weakened as physicians have gotten too busy, overloaded and overworked for those morning briefings.
But even more than those occupational difficulties, radiologists and other providers are now faced with rapidly advancing technology that allows for convenient filing into electronic medical records and quick report turnaround using voice recognition. That new culture of efficiency, Zember et al. wrote, has had some “unexpected negative consequences.”
“Today, digital images are readily available to clinicians at patients’ bedsides and even on their telepresence devices,” the authors wrote. “Paired with a radiologist’s digital report, this makes it tempting to forgo radiology consultation altogether. This is unfortunate and counterintuitive, as interdisciplinary interaction has been shown to improve patient care and interdepartmental relations.”
Indeed, Zember and his team said, prior research has found that up to 80 percent of radiologists derive some benefit from morning rounds, which can have significant impact on the course of treatment or clinical interpretation of many cases. In an effort to promote that teamwork, the authors reinstated rounding within the pediatric and neonatal ICUs at Children’s, where such briefings hadn’t existed for 10 years.
The researchers made some tweaks to the original format of the rounds: this time the 15- to 20-minute meetings were virtual, delivered by an attending radiologist or pediatric radiology fellow to a conference room of their peers via Skype. Presenters spent around three minutes on a microlecture, Zember et al. explained, before reviewing five or so current cases.
The team evaluated the approach with surveys and questionnaires, which were collected before, during and after the 17-session trial. They found 20 percent of participants felt there was a major improvement in confidence after morning rounds were reinstated; 68 percent saw a moderate improvement and 12 percent reported no change.
“In our study, radiologists who were accustomed to reading studies without clinical input felt that the interaction with clinicians provided a positive benefit to the image interpretation,” Zember and co-authors wrote. “The NICU clinicians believed that they required less consultation with radiologists for plain films, yet still heavily relied on radiologists for cross-sectional or nuclear medicine imaging studies.”
The study demonstrated a strong link between interactive rounding and clinical patient care, the authors said. Though they were short, the microlectures seemed to have a profound impact on pediatric trainees, who received varying degrees of formal radiology instruction during their training.
Aside from education and confidence, the authors said, the collaborative rounds also reinforced or altered the clinical plan of care for many cases.
“Through the creative use of technology, it is possible to circumvent workflow limitations to recreate meaningful consultation and radiology education between radiologists and ICU physicians,” they wrote. “Bringing radiologists closer to the point of care and improving interaction with referring providers has the potential to further improve patient care.”
After graduating from Indiana University-Bloomington with a bachelor’s in journalism, Anicka joined TriMed’s Chicago team in 2017 covering cardiology. Close to her heart is long-form journalism, Pilot G-2 pens, dark chocolate and her dog Harper Lee.