Radiology report follow-up recommendations: 4 ways to improve patient compliance

One out of every seven radiologist follow-up recommendations contained in imaging reports is not carried out, experts recently reported in JAMA Network Open

“Recommendations for additional imaging (RAIs) are found in more than 10% of all reports, yet adherence rates range from 29% to 77%. Such lack of follow-up has the potential to cause substantial patient harm and malpractice risk, particularly by causing delayed diagnosis and treatment of cancers and other serious diagnoses,” corresponding author Gordon D. Schiff, MD, with the Center for Patient Safety Research at Brigham and Women’s Hospital, Harvard Medical School, and co-authors recently discussed. 

Schiff and colleagues sought to investigate what factors influence patient follow-through, as well as how such factors can be adjusted to improve patient compliance. For this, they analyzed 598 radiology reports from a primary care clinic at a large academic center, each of them containing follow-up recommendations.  

The authors paid particular attention to three domains—specific instructions, recommended completion time frames and contingency language qualifying the recommendation. An overall rate of 87.4% of completed follow-up actions was observed, of which 31 cases were revealed to pose substantial clinical risks for patients. 

Three factors that were found to positively influence compliance were: 

  1. Clearer, more concise language with the absence of accompanying contingency verbiage (example: “if warranted depending on clinical correlation”). 

  1. Shorter recommended time frames. 

  1. Evidence of direct communication between the radiologist and referring provider

The experts suggested that having standardized processes and templates in place for actionable recommendations could avert consequential missed follow-ups, noting that the radiology department involved in the study had dedicated report sections for actionable recommendations

In addition to dedicated recommendation fields, the authors put forth the following suggestions for increasing follow-up loop closures: 

  1. Provide clear, less conditional recommendations. 

  1. Create scheduling and referral systems specifically for follow-up exams. 

  1. Enact more reliable systems for patient transfers when PCPs change practices. 

  1. Follow-up with patients who do not schedule or miss their recommended exams. 

“Although the relatively high loop closure rate reported herein is a testament to the efforts by PCPs, future work applying a system engineering approach is needed to better understand workload and vulnerable steps in our current systems.” 

View the full study for free here

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