Radiologists, Show Your Face

The intensive care unit is a big consumer of radiological services. Portable chest X-rays are obtained daily for intubated patients; clinicians have lower thresholds for imaging critically ill patients. As a resident in the medical and surgical intensive unit this past month, I found that imaging is crucial to the diagnostic and treatment process. A day’s work includes reviewing images during pre-rounds preparation, discussing these images with the team as we round in front of each patient’s room, and afterwards, following up on new imaging and taking the time to look at studies more in-depth.

As an integral part of the process, some institutions have incorporated “radiology rounds” into the daily routine. For example, the critical care program Web site of Stanford School of Medicine lists visiting the chest reading room as part of the morning routine. These in-person meetings with radiologists may be a good way to promote diligent, quality care. Not only do these meetings ensure that clinicians review imaging for every single patient, but it is also a huge asset to have a live interpretation from the radiologist who can answer real-time questions and address concerns on the spot. This may be ultimately time-saving for the primary team and improve patient outcomes.

Several studies have shown that face-to-face meetings between physicians and radiologists can prevent errors and impact patient safety in a significant way. The Michigan Radiology Quality Collaborative looked at in-person communication between radiologists and acute care surgeons and showed that out of 100 patients, significant alterations (43%) were made in surgical diagnosis and planning. These targeted sessions of in-person collaboration seemed to strongly influence decision-making even when the original report contained all the necessary data. [[{"type":"media","view_mode":"media_crop","fid":"47444","attributes":{"alt":"In-person radiology rounds","class":"media-image media-image-right","id":"media_crop_5613851279333","media_crop_h":"0","media_crop_image_style":"-1","media_crop_instance":"5594","media_crop_rotate":"0","media_crop_scale_h":"0","media_crop_scale_w":"0","media_crop_w":"0","media_crop_x":"0","media_crop_y":"0","style":"height: 200px; width: 200px; border-width: 0px; border-style: solid; margin: 1px; float: right;","title":"©attem/Shutterstock.com","typeof":"foaf:Image"}}]]

Interestingly, there were major discrepancies (RADPEER score ≥3) between the written report and the reviewing radiologist’s read in 11% of cases. These latter changes may be influenced from having more information from the consulting physician about the patient’s condition. Eleven out of 100 studies is a significant number, and suggests that in-person meetings may be of benefit as a reiterative process for improving accuracy of radiology reports. The reading provided by the attending radiologist with the consultation of the surgeon during these rounds is considered to be final.

Another study looked at discordance in radiology readings between external overnight radiology services and staff radiology readings at a level one trauma center. Five-hundred and thirty four CT scans over three years were reviewed and discordance was measured by a substantive change in patient care. Results showed that the discordance rate was 16%, and 29% of the clinically significant missed findings were identified after trauma service rounds with staff radiology.

In-person communication between radiologists and referring physicians may improve mutual understanding and foster better future communication. Expanding team communications by including members with diversity in training and experience has been shown to improve overall team effectiveness. Moreover, face-to-face interaction drives higher levels of positive collaboration while lowering the amount of conflict in comparison to sterile electronic communications.

The model of in-person radiology rounds is an integral part of some services, but may be a radical change for other services. It requires dedication and commitment of time and effort from both radiologists and referring physicians alike.

Do in-person rounds work for you? Does your hospital employ an alternative process? Comments welcome below.