Embedded reading rooms mean more face time with clinicians

Embedding reading rooms in clinical areas, rather than locating them centrally in a separate area of an institution, increased the amount of face-to-face interaction between radiologists and clinicians, according to a study published in the May issue of the Journal of the American College of Radiology. The researchers reported highly statistically significant differences in communications between radiologists and referrers depending on the reading room configuration.

Despite the significant differences in interactions between the reading rooms in the study, authors Allison A. Tillack, PhD, of University of California, San Francisco, and James P. Borgstede, MD, of University of Colorado at Denver, said culture also could play a significant role. Specialty groups could be particularly committed to face-to-face meetings with radiologists, or vice versa.

“Thus, the variability in communication practices that we documented could be due to reading room location but could also reflect patterns related to the specialties of the referring physicians or of the subspecialized radiology groups that are independent of location,” wrote Tillack and Borgstede.

Study findings were based on observations from four reading rooms, two embedded rooms focused on musculoskeletal and breast imaging, and two nonembedded reading rooms focused on neuroradiology and body imaging. A total of 175 episodes of communication between radiologists and referring physicians were observed, with the authors tracking whether communication occurred face-to-face, over the phone or through the institution’s critical test result management (CTRM) system.

In the 100 observed communications between radiologists in the embedded reading rooms and referrers, 47 percent took place over the phone, 46 percent were visits and 7 percent were via CTRM, reported Tillack and Borgstede. In the 75 observed communications involving nonembedded reading rooms, 53 percent occurred over the phone, 7 percent were visits and 40 percent were via CTRM. The difference in percentage of visits and CTRM messages between embedded and nonembedded reading rooms was highly statistically significant, though differences in the proportion of calls was not significant, according to the authors.

Tillack and Borgstede were spurred to conduct the study because there was a lack of research on the topic, and there is a growing use of highly structured, unidirectional, automated electronic communication systems like CTRM. “This alteration in physician relationships has sparked widespread concern among radiologists that they are increasingly being viewed as ‘disembodied functionaries’ rather than as colleagues by referring physicians,” they wrote. “Many scholarly articles and editorials in radiology journals have emphasized the importance of interactive, bidirectional radiologist-clinician communication in the PACS era.”

While the question of how much department culture could affect interactions, the authors said the study has value for documenting the high degree of variability in communication practices among different kinds of radiologists and referring physicians. “The extent of these different practices among the four reading rooms has important implications for future studies on communication patterns between radiologists and referring providers as well as for designing effective interventions to enhance the role of radiologists as consultants. “