Closed-loop communication can improve the value of radiologists’ recommendations for additional imaging by reducing unnecessary suggestions and also increasing the likelihood of patients completing relevant recommendations.
Radiologists routinely make recommendations for additional imaging (RAI) in their dictations, but when these are provided in excess or do not provide all the information necessary for referring providers (rationale, time frame, imaging modality, etc.), patients might sometimes undergo unnecessary and costly evaluations to either confirm or rule out diseases. In recent years, a group of experts at Brigham and Women’s Hospital in Boston, Massachusetts proposed that feedback reports from referring providers and closed-loop communication systems could improve the value of radiologist-recommended follow-up imaging.
After implementing their own closed-loop system between referring providers and thoracic radiologists, the group observed an overall decrease of more than 35% in incomplete RAI, in addition to improved follow-up adherence to readers’ recommendations. They detailed their observations June 10 in the Journal of the American College of Radiology.
“There is significant variation in the frequency of RAI among radiologists, which may lead to low-value care through unnecessary additional tests in the follow-up of incidental or uncertain findings, some of which may be benign or not clinically relevant,” corresponding author Ariadne K. DeSimone, MD, MPH, and colleagues explained. “At least some variation in RAI may be due to radiologist’s incomplete knowledge of a patient’s full clinical presentation, while an unknown portion may reflect radiologist diagnostic uncertainty.”
Implementing their system was a two-step process. The first step involved a feedback report period when radiologists were provided with their personal RAI rates, blinded RAI rates for their colleagues and an idea of where their own stats were in comparison to their peers.
The second step incorporated a closed-loop communication and tracking IT tool in addition to the reports. The tool enabled direct communication pertaining to RAI between radiologists and referring providers; referrers could either agree or disagree with the RAI and provide feedback supporting their decision. It also allowed physicians to provide timelines for when the recommendations should be completed and the ability to track the process. The tool was integrated into the institution’s EHR and PACS systems and alerted both parties when updates in the follow-up process were available.
A comparison of pre- and post-intervention periods revealed that the system reduced rates of RAI by approximately one percentage point after implementation. It also decreased the rate of incomplete RAI from 84% pre-intervention to 48.5% post-intervention.
“These findings suggest that encouraging use of a closed-loop communication and tracking system that requires entry of rationale, time frame, and imaging modality for each RAI could improve completeness of RAI while decreasing incomplete, unclear, or vague recommendations and overall RAI rates,” the group concluded.
The study abstract is available here.
In addition to her background in journalism, Hannah also has patient-facing experience in clinical settings, having spent more than 12 years working as a registered rad tech. She joined Innovate Healthcare in 2021 and has since put her unique expertise to use in her editorial role with Health Imaging.