How to repair a rocky relationship between radiology, EM departments

When healthcare providers act in an unprofessional manner, it can have a negative impact on patient care. So what are leaders to do when they notice unprofessional behavior spreading throughout entire departments? The authors of a recent analysis in the Journal of the American College of Radiology noticed a brewing feud between their institution’s radiology and emergency medicine (EM) departments—and decided to do something about it. 

“Despite frequent interdepartmental interactions between the radiology and EM departments at our institution, anecdotal incidences of unprofessional behavior had been noticed without formal acknowledgment or attempts at resolution,” wrote Kenny Q. Sam, DO, department of diagnostic radiology at Baylor College of Medicine in Houston, and colleagues. “Some members of each department felt that at times affiliates from the other department could be confrontational, condescending, or rude. There was also a general misunderstanding of certain rules and protocols that the other department members prioritized, which directly affected both departments.”

It was decided that a small group of faculty members and residents from both departments would get together to discuss these ongoing issues. First, they developed a 20-question survey so that faculty and residents of each department could “evaluate their current perception of professional behavior between the two groups, describe situations in which unprofessional behavior had been observed, and identify areas for improvement.” All responses were anonymous.

Intradepartmental conferences were then held in both departments. Survey responses and potential solutions to the ongoing problem were discussed at length. It was determined that three key issues needed to be addressed to improve the relationship between these departments: “communication, shared information and protocols, and misconceptions.”

Communication:

From the various meetings and survey responses, it became clear that the two departments lacked an “open and respectful dialogue.” Becoming more familiar with one another was then made a top priority.

Shared information:

“It was discovered that the radiology and EM departments had different repositories with different versions of the information, which were supposedly ‘shared’ between the two departments, although no one knew about the other department’s database,” the authors wrote. The team then compared notes to make sure they were using the most up-to-date information and put a process into place “to ensure that future updates to one database would be made to both.”

Misconceptions:

According to Sam et al., they quickly realized that each department had misconceptions about the other.

“For instance, there was frequent frustration among the radiology group regarding the demand from the EM department for ‘wet reads’ or to prioritize certain studies from the emergency room,” the authors wrote. “The radiology respondents were concerned that these preliminary reads interrupted workflow and could lead to incomplete or erroneous interpretations. Unbeknownst to the radiology group was the pressure the emergency department was under for efficient patient throughput; having a preliminary read on a patient would allow appropriate triage and thus EM productivity.” It was decided that a biannual conference between the departments could help reduce such misconceptions and get everyone on the same page.

All of these various ideas for the future were all put into place and then, after a set period of time, a “joint grand rounds conference” was planned to discuss feedback.

A survey after the grand rounds conference found that more than 94 percent of respondents thought the conference “increased their understanding of the other department.” More than 70 percent of respondents said they thought “behavior would be more professional as a result of the conferences.”

“Overall, the combination of anonymous surveys and multidisciplinary meetings between the radiology and EM departments was shown to be an effective method to address issues and promote a culture of improved professional behavior between the two departments,” the authors concluded. “Changing the perception of interdepartmental professionalism is a long-term process that requires a change in culture and system processes.”