Do it right the first time: 5 ways to reduce repeat imaging

Recalling a patient to repeat an imaging request is inconvenient for both the patient and the healthcare provider. According to a recent study published by the American Journal of Roentgenology, if a facility notices this happening regularly, it may be an indication that certain processes need to be updated.

Researchers from the NYU Langone Medical Center in New York City, studied 100 instances from January 2012 to March 2015 when repeat imaging was requested due to an inadequate imaging study in the ambulatory setting.

Overall, the facility averaged 2.6 requests per month, making it a fairly rare occurrence. But Soterios Gyftopoulos, MD, and colleagues still decided to dive deeper and see how they could work toward making patient recall even less frequent going forward.

“Patient recalls for repeat imaging should be nearly entirely avoidable, and given the volume of ambulatory imaging nationally, may account for a substantial number of unnecessary repeat examinations,” the authors wrote. “Our findings indicate that there may be opportunities for departments and radiology practices similar to ours to improve imaging quality and reduce the need for patient recalls.”

1. Consider additional employee education

Incomplete examinations were the most common reason for patient recall to be requested, making up 24 percent of all requests. One way to cut down on such “active errors,” the authors explained, is to improve or increase employee education.

“Improved technologist and radiologist education on imaging protocols and the importance of adequate coverage during imaging may be necessary, especially for imaging examinations that are infrequently ordered or commonly performed incorrectly,” the authors wrote. “At our institution, we have begun a teaching seminar series for the technologists to review and discuss new or difficult protocols, such as metal MRI of the hip, preoperative and postoperative brain MRI, and advanced liver MRI. These seminars are organized by radiologists and lead technologists and provide a platform to review the pertinent imaging techniques, discuss problem areas, and answer questions that the technologists may have.”

2. Mandatory technologist checklists

Requiring technologists to fill out checklists after the completion of imaging exams serves as a “final audit” of the process, ensuring protocols have been adhered to in full and patients should not have to be recalled.

3. Improve radiologist-technologist communication

Gyftopoulos et al. wrote that another way to limit incomplete examinations is to improve communication. When the technologist and radiologist are a PACS direct message or phone call away from speaking to one another, it can help “improve the likelihood of appropriate imaging being performed.”

4. Improve protocoling

Communication also comes into play with another common reason for patient recall requests: errors in protocoling. Protocoling is an area of imaging that is often overlooked, the authors wrote, but it is certainly important. And a lot of the time, the issue is in the imaging request itself, not anything the technologist has done incorrectly.

“On the basis of our review of the imaging reports and patient recall requests for these cases, it appears that the degree of incompleteness of the clinical information was unknown to the individuals performing the protocoling,” the authors wrote. “That is, it appears that the orders were unclear or deficient, but that the deficiencies were not obvious to the technologists.”

5. Adult patients should be treated with the concern and care shown toward younger patients

Ninety-eight percent of the patient recalls involved adults, which the authors said is partially due to the additional attention given to pediatric patients during examinations.

“For instance, there appears to be increased communication between the ordering physician and imaging stakeholders when a pediatric patient is considered for CT to ensure the test is done correctly, given the associated radiation dose and associated risks,” the authors wrote. “Similarly, younger patients undergoing MRI may need to be placed under sedation to avoid patient motion and the associated artifact that can limit the diagnostic effectiveness of the imaging. In these cases, a radiologist typically reviews the imaging with the patient in the scanner to ensure that the examination is being performed correctly. These types of lessons from our pediatric imaging workflow can be applied to our adult imaging, which could improve the overall imaging quality and decrease the safety-related risks.”