Outsourcing may actually be adding to in-house radiologists' workloads
New research suggests that outsourcing radiology reporting may lead to significant increases in inappropriate imaging orders.
Published in Clinical Radiology, the new data indicate that imaging reports completed via teleradiology often contain recommendations for additional imaging; in up to a quarter of these cases, the follow-up suggestions are inappropriate and/or lack clinical proper clinical justification. As many organizations are turning to teleradiology services to keep up with imaging demand, it is becoming increasingly important for leaders to evaluate how this practice affects patient care, radiology workflows and the bottom line, authors of the new paper contend.
“In addition to the growing costs associated with an increasing reliance on outsourcing, external reporting potentially brings with it other impracticalities. These may include the challenge clinicians face when trying to discuss findings on scans, a misunderstanding of or lack of access to up-to-date clinical details, a disparity in referral thresholds and a lack of knowledge of local referral and onward management guidelines,” Samuel Ebbs, with the Royal United Hospitals Bath NHS Foundation Trust in the United Kingdom, and colleagues explained. “This can lead to outsourced reports of more limited value, with images requiring further in-house review and ultimately added workload for the radiologists in the base hospital.”
For their analysis, the team focused on CT scans of the chest, abdomen and pelvis. They reviewed 248 studies reported by outsourced radiologists, placing emphasis on the readers’ imaging and non-imaging recommendations. The recommendations were assessed for appropriateness and compared to those provided by in-house consultants.
Compared to in-house reads, outsourced reports were significantly more likely to include recommendations for additional imaging. In 26% of cases, those recommendations were deemed inappropriate compared to just 4% of recs from in-house radiologists. What’s more, there were more instances of vague or unclear recommendations from outsourced readers.
“This has the potential to increase the workload and costs for local radiology departments, in turn reducing the cost-effectiveness of outsourcing as a means of tackling the increasing reporting demand,” the authors noted.
These findings are likely owed to issues with access (to medical records, lab reports, etc.) and communication. Teleradiologists do not always have access to in-house clinicians to discuss findings or clinical scenarios, and vice versa, which can make it difficult to determine the most appropriate follow-up. As a result, many may err on the side of caution and recommend additional follow-up imaging to cover their bases.
The team suggested that improving access to EHR information and clinicians could be beneficial for organizations considering outsourcing radiology reporting.
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In addition to her background in journalism, Hannah also has patient-facing experience in clinical settings, having spent more than 12 years working as a registered rad tech. She began covering the medical imaging industry for Innovate Healthcare in 2021.