Study: Reports recommending imaging follow-up are ignored

Abnormal imaging results accompanied by recommendations for further imaging aren’t necessarily followed up on a timely basis, according to a study in the Journal of the American College of Radiology.

In their study, Aymer Al-Mutairi, MD, and colleagues hypothesized that there are two communication-related items in radiology reports that could affect follow up—recommendations for further imaging and expressions of doubt concerning the results.

“Specifically, expressions of doubt may contribute to a sense of ambiguity about how to further manage a patient’s condition, resulting in a lack of timely follow-up,” they wrote. “Similarly, recommendations for additional testing require physicians to take additional steps to investigate the problem in the midst of their otherwise busy daily schedule.”

In order to assess the affect these communication issues have on follow-up imaging, the authors performed a retrospective study of radiology reports for 250 patients (part of a cohort of almost 1,200 patients from a previous study that examined follow-up of abnormal imaging report-related alerts in the VA’s electronic health record).

Ninety-two of the reports had been identified as lacking timely follow-up at four weeks.  The authors then randomly selected another 158 reports with timely follow-up actions to reach a sample size of 250.

The authors found that that there was a relationship between further imaging recommendations and a lack of timely follow-up.  According to the authors, about 75% of patients without timely follow-up had reports with recommendations for further imaging, compared to just 58% of those with timely follow-up.

On the other hand, the authors found that expressions of doubt in radiology reports had little effect on follow-up actions.

“The finding underscores the potential need for developing additional safeguards that allow for better monitoring and tracking of patients with recommendations of further imaging to ensure appropriate follow-up actions,” the authors wrote.

For example, the authors wrote, while EHRs and other automated tools facilitates communications between radiologists and referring physicians, the study suggests that studies recommending a follow-up imaging test are still likely to be lost to follow up.

“Thus, other mechanisms must be in place to prevent such reports from ‘falling through the cracks,’” the authors wrote. “For instance, IT-based solutions to track patients with abnormal imaging results can remind providers or their care team members to take appropriate action. Tracking systems may be especially helpful when next steps are not immediately clear.”