The 4 most common communication errors in radiology, according to 1 institution

A new single-center study explores the most common causes of communication errors in a radiology department. 

Over 80% of malpractice lawsuits stem from such mistakes, attorneys estimate. In radiology, roughly 38% of communication errors adversely impact patient care, researchers detailed Friday in JACR.

Investigators with Beth Israel Deaconess Medical Center recently aimed to understand the root causes of communication mishaps in imaging. To do so, they adapted a previously created classification system for examining errors in the operating room. 

They then used it to help digest four years’ worth of safety data from an academic health system.

“We hope this error classification schema facilitates the development of specific countermeasures and improves patient outcomes,” lead author Meghavi Mashar, MD, with Boston-based BIDMC’s Department of Radiology, and colleagues wrote May 2. 

The study spanned 2018–2021, with the authors pinpointing any communication issues found in the hospital’s databases. A quality assurance director and nurse reviewed the reports prior to running the classification system. Their search turned up a total of about 300 distinct errors across 285 incidents. Most occurred during performing the imaging exam (65%) or within the radiology report (19%). Less commonly, communication mistakes also happened during ordering (7%), post-procedural care (6%) and scheduling (3%). 

The four most common error types, making up about 80% of cases, were: 

1. Missing information accounted for about 31% of radiology errors. To remedy this, Mashar and co-authors believe: “Improved access to critical information via standardized protocols, checklists, and better visual display in the electronic medical record are essential.” 

2. Lack of closed loop communication was second most common, leading to 23% of errors. While follow-up imaging is typically the focus in these instances, the study also found failures to close the loop during exam prep and handoff afterward. 

“Standardized radiologist/technologist communication protocols around examination performance would address the most common type of vulnerable communication within the radiology department,” the authors advised. “Interestingly, 96% of closed loop errors occurred within teams. Electronic tools such as team chats may be useful.”

3. Key individual not contacted was the cause of about 14% of errors, occurring when closed-loop protocols are in place but not followed. Reaching these individuals can be difficult due to their other responsibilities and especially during transitions of care. 

“Inadequate contact information in radiology practices with large referral networks from out-of-network providers and unclear policies of when to contact a [key individual] for imaging results may be additional challenges,” the authors advised. “Electronic communication may be useful, but attention must be paid to data organization, notification volume and usability.”

4. Inaccurate information was the driver of about 12% of radiology communication errors. Previous studies have found errors in about 22% of radiology reports, most commonly relating to laterality (left or right?) and “descriptor misregistration” by speech recognition (one or none?). 

“Structured reports and artificial intelligence tools may be useful countermeasures,” the authors wrote. “Differences in statements between the body of the report and the impression, such as ‘gallstones’ and ‘no gallstones’ could potentially be avoided with AI generated impressions. Unfortunately, some reporting errors are not yet avoidable, such as right/left confusion within duplicate organs like kidneys.”

Read more about the results, including potential study limitations, in the Journal of the American College of Radiology.