Advice from the ED to improve radiology reporting: Speed and structure top most wish lists
Emergency medicine providers most desire “brevity” and clarity” in radiology reports, according to a new survey released this week.
“Accuracy” and “completeness” in answering the clinical question are also top-of-mind, researchers found in a quiz of nearly 70 caregivers in one United States ED. Emergency physicians, residents and nurse practitioners also have a high desire for structure in these reports.
Some radiologists may balk at such a request, preferring to stick to the autonomy of free-form reporting, study author Waleed Abdellatif reported Feb. 24 in the Canadian Association of Radiologists Journal. However, he and co-authors urged clinicians to make the switch, which could help maximize patient safety while minimizing malpractice claims.
“Although some radiologists may be resistant to change, it should be agreed upon that any measure that may curtail diagnostic errors should be actively welcomed and encouraged,” wrote Abdellatif, an emergency radiology fellow at the University of British Colombia in Vancouver, and colleagues. “Studies have shown that structured reports play a role in discovering clinically significant findings, which may be overlooked with an unstructured reporting style. The occurrences of diagnostic errors could potentially see a notable reduction, thus serving as a valuable advantage of using a systematic and structured reporting system.”
To back up this claim, Abdellatif and co-authors noted that more than 77% of ED respondents prefer a separate section for each organ system on the radiology report’s “findings” section. More than 45% also favored a structured list of short descriptions, rather than “free text.” And even with simple exams like ankle radiographs, about 53% of ED providers said they preferred structured, system-by-system findings, followed by the radiologist’s impressions.
The findings were part of a nine-question online survey of ED staffers, aimed at exploring the “business-oriented scope” of radiology reporting, rather than the medical side. In this lens, Abdellatif wrote, such reports are seen as “products of radiologists that are meant to be delivered to a wide array of clients,” with an emphasis on reliability and accountability.
Overall, respondents said they’re satisfied with radiology reporting in the ED (90%), along with the language used (84%), vocabulary (78%) and proofreading (72%). In the open-ended section of the survey, brief and concise impressions and recommendations showed up most frequently, in about 31% of responses, followed by timely preliminary reports (17%).
On the negative side, caregivers were bothered most by format- and structure-related issues, hedge terms, delays in reporting, poor communication and documentation issues. Asked for possible remedies to their gripes, ED clinicians offered up suggestions such as focused reporting, tailored to the clinical question (20%); faster reporting (20%); and modifications to the impression section (17%).
Effective communication also showed up on multiple wish lists. Picking up the phone to relay urgent findings ahead of the report is a small but immensely helpful gesture to some ED providers, Abdellatif and co-authors found.
“Inefficient communication between radiologists and ED clinicians can result in serious consequences such as inadequate patient outcomes, delayed treatment, legal liabilities and lost revenue,” they reported. “Our survey noted that the respondents disliked it when radiologists solely relied on their reports and did not convey emergent and acute findings directly through the phone.”
Marty Stempniak has covered healthcare since 2012, with his byline appearing in the American Hospital Association's member magazine, Modern Healthcare and McKnight's. Prior to that, he wrote about village government and local business for his hometown newspaper in Oak Park, Illinois. He won a Peter Lisagor and Gold EXCEL awards in 2017 for his coverage of the opioid epidemic.