Hospital quality improvement project aims to reduce radiologists’ administrative burden

An academic hospital has launched a quality improvement project aimed at standardizing multidisciplinary conferences and reducing radiologists’ related administrative burden. 

Members of the specialty play a pivotal role in these situations, impacting treatment decisions for patients with diverse oncologic conditions. Abdominal scans can show a particularly high discrepancy rate when compared to the original interpretation, experts wrote in the Canadian Association of Radiologists Journal [1]. However, clinical information provided to specialists preparing for these conferences can vary widely. 

The University of Toronto has aimed to standardize the process, conducting a survey of participating abdominal radiologists to determine how to make their lives easier. 

“Radiologists are key contributors to [multidisciplinary case conferences], which are crucial in the management of complex patient cases and have been shown to enhance communication and clinical decision-making,” Ania Kielar, MD, an abdominal specialist and associate professor with the university’s Joint Department of Medical Imaging, and co-authors wrote Sept. 18. “Standardizing MDCs resulted in improved provision of image location and greater inclusion of clinical information. This allows for more efficient and consistent preparation, thereby potentially reducing administrative burdens for radiologists.”

For the initiative, U of T distributed anonymous electronic surveys to abdominal radiologists who participate in 1 or more of their 28 case conferences. They received responses from 27/32 (84%), with each rad participating in 1-6 conferences. Time spent on preparation each week ranged from 0.5 to 7 hours or an average of 2.8 hours per week. 

Several potential improvements emerged from the surveys, Kielar and colleagues noted. For instance, radiologists said case conferences rarely provided info on where to find the images, be it the university’s internal PACS or the external exchange system, ConnectingOntario. Remedies included uploading external images to the institutional system, timely provision of the list of patients for review (with no last-minute add-ons), protected time for preparation, and setting a max number of patients for review. 

The University of Toronto distributed a standardized Excel template to all multidisciplinary case conference managers. Physicians also were instructed to send cases no later than 36 hours prior, and template adherence was assessed at 1.5 and 8 months. A follow-up survey at four months showed that instances where radiologists were told where to find images increased from 36% at baseline to 70% at follow-up. Nonadherence to the 36-hour cutoff decreased from 36% to 17%. About 41% of abdominal radiologists noted improved standardization versus 18% who saw no change. (Those in the latter category experienced a higher rate of case managers failing to adhere to the 36-hour cutoff.) About 89% of case conferences adhered to the new Excel template. 

Kielar et al. believe this is one of the first quality initiatives focusing on multidisciplinary case conference efficiency and effectiveness. They’re eyeing further changes, including integrating standardized requisitions within the Epic electronic health record system. 

“This would allow for a record of final group decisions, creating a repository specific to each patient that would streamline future reviews,” the authors noted. “Epic integration may also allow for force functions, which would ensure that cases are requested within a reasonable timeframe before the MDC, guarantee the inclusion of sufficient information on patients’ clinical backgrounds, and maintain a reasonable maximum number of cases. Automation and large language models dedicated to radiology may also play a role in retrieving imaging from external sources such as ConnectingOntario.”