Common reasons why a radiology department rejects requests for diagnostic imaging
New research published Wednesday explores some of the common reasons why one radiology department rejects requests for diagnostic imaging.
Radiologists, techs or schedulers typically review all imaging orders before completion, which may result in the exam’s cancellation, forcing the referrer to place a new order that addresses any concerns.
“These occurrences can result in process inefficiencies,” Jerard Z. Kneifati-Hayek, MD, MS, a professor and internal medicine specialist with the Columbia University Irving Medical Center, New York, and colleagues detailed Sept. 17 in the American Journal of Roentgenology. “Insights into factors associated with order cancellation by the radiology department could guide interventions to improve ordering practices and thereby aid radiology workflows.”
To better understand this issue, researchers analyzed data from the electronic health records of an unidentified, six-facility healthcare system, logged between 2021 and 2023. The search turned up a total of nearly 7.5 million imaging requests across 1.1 million unique adult patients. Of those, the radiology department canceled nearly 256,000 or about 3.4%.
Breast imaging exams were about five times more likely to be canceled than other scan types, while contrast enhancement and emergency department orders were about twice as likely. Order cancellation rates were higher for black patients (1.45) than white ones and for Spanish- (1.11) and Mandarin-speaking (1.11) subjects versus those who use English. Additionally, orders placed by trainees (1.55) were likelier to be canceled compared to clinicians in other categories.
Two internists analyzed a random sample of 100 canceled orders, excluding breast imaging exams, to determine whether the original request was typically reordered or modified. Providers placed an altered order in 96 instances, with the most common modifications involving the number of views obtained (34) and IV contrast media utilization (24). In the other four cases, the referrer reordered the original exam without making any changes, the authors found.
“The identified associations of factors with imaging order cancellations highlight potential sources predisposing to error and opportunities to improve ordering practices,” Kneifati-Hayek and co-authors advised. “These factors could be targeted in efforts to improve diagnostic imaging workflow processes and efficiencies, while reducing potential errors,” they added later.
Researchers urged others to devise potential strategies to improve ordering across the ED, when using IV contrast, and with orders placed by medical trainees. In addition, the association of cancellations with Spanish and Mandarin languages highlighted the “importance of optimal patient-referrer communication during the ordering process,” the authors advised.
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.