How Radiologists Can Interact Effectively With Referring Physicians

Questions asked at RSNA 2017 have been plaguing radiologists for years: Where do radiologists fit in with the overall clinical care team? And how do radiologists ensure that patients ultimately receive benefit from what they report?

In the digital age, referring physicians are overwhelmed with test results and alerts (sometimes more than 60 a day). It is clear that in order to deal with this information overload, something has to facilitate the results getting to the patient and referring physician. Some suggest a team-based approach is necessary to make sure all information is reviewed and addressed. The costs of errors in missing a patient’s diagnosis leading to malpractice claims is large and it is time to determine new ways of preventing these errors.

The referring physician might be the one to meet with and treat the patient, but the radiologist is essential to help the referring physician understand what is going on with the patient. Radiologists are savvy with technology and able to deal with complex information, so patients are dependent on radiologists to help with information transmission and not let their test results fall through the cracks of the health care system.

Annette J. Johnson, MD, MS, alluded to a scary picture when considering the percentage of cases with missed or delayed diagnoses because of referring physician cognitive errors. Her story continued with patient harm as a result of breakdowns in the diagnostic process, such as failure to order the appropriate test or failure to create an appropriate follow-up plan. Johnson presented what other institutions have tried, such as increasing the number of alerts to physicians or having the patient complete a follow-up visit to try to reduce errors, however, neither option results in improved outcomes, she said.

What types of tools can radiologists use to communicate with referring physicians?

Andrew Rosenkrantz, MD, shared details about what radiologists at New York University have developed to reduce the errors and communication issues between referring physicians and radiologists, and improve referring physicians’ understanding of the radiologist’s findings.

1. Virtual Consult: An application interfaces with the radiologist and referring physician. With the push of a button, they can launch a consult with the radiologist when the report is delivered. There is a chat function and the physician can also screen share with the radiologist. This service is accessible throughout NYU’s locations and one radiologist per subspecialty designates themselves as the sections’ virtual consultant. Favorable reviews by referring physicians cite improved access and help with patient follow-up. Radiologists found it somewhat disruptive to their workflow, but otherwise felt it enhanced integration into the care team.

2. Virtual Rounds: Large high-resolution monitors placed in a clinical unit’s conference room and video cameras in both clinical units and reading rooms are used with a WebEx infrastructure to host the rounds at mutually convenient times. This provides an opportunity for residents (radiology and clinical unit) to talk through important issues with different departments. Radiologists reported increased integration into the clinical care team.

3. Reading Room Coordinators: Hiring coordinators in the reading room has reduced radiologist burnout. There is a task window to contact the coordinator to address a problem and get it solved, such as contact referring physician, contact IT, and bring up old file. There is high usage of more than 3,000 coordinator tickets in a month with quick turn around on requests (2 minutes to pick-up request and 5 minutes to complete request).

4. Embedded Reading Rooms: Establishing a reading room in the referrer’s practice location provided referrer’s and patients with greater access at the point of care. They staffed the reading room for half the day, but this did not require additional staffing requirements.

These types of consults and embedded reading rooms integrate the radiologist as a central part of the clinical care team and helps build the bridge of communication with the referring physician. Although NYU has multiple modes of improving radiologist interaction with referring physicians, it is important for each practice and institution to discuss what technologies fit with current workflows and work best for their radiologists and physicians.