Structured reports with a 'forcing function' for recommendations improve follow-up adherence
Structured report entry tools with closed loop communication features significantly increase radiologist-recommended follow-up adherence.
That’s according to new data published March 31 in JAMA. In a study that included hundreds of radiologist recommendations for additional imaging, there was a threefold increase in follow-up adherence when radiologists utilized a voluntary closed-loop communication tool that required structured recommendations.
Experts involved in the analysis suggested that the use of similar tools could potentially improve patient outcomes.
“It is challenging to ensure timely performance of radiologist-recommended additional imaging when radiologist recommendation language is incomplete or ambiguous,” corresponding author of the new paper Jeffrey P. Guenette, MD, with the Department of Radiology at Brigham and Women’s Hospital in Boston and co-authors explained. “This study suggests that supplementing radiologist free-text dictation with voluntary use of a structured entry tool for clinical attributes was associated with increased recommendation completeness, which may enable improvement initiatives for timely performance of clinically necessary recommendations.”
To test the tool’s effectiveness, experts analyzed 336 consecutive radiology reports containing recommendations for additional imaging, comparing follow-up completeness before and after the tool’s implementation into workflows. Structured recommendation attributes required radiologists’ entries to include a suggested timeframe, modality and rationale.
Prior to the intervention, follow-up completeness was measured at 14%. One year after the intervention, this figure increased to 46%—a more than threefold increase in compliance.
However, one-third of the recommendations filed with the tool still contained ambiguous language, which the team noted as something that can be problematic for referring providers.
“Recommendations that contain alternate language are challenging because they imply that the ordering clinician ordered the wrong test,” the group explained. “Recommendations with a multiplicity of choices defer the choice of imaging examination to another clinician, who may not know the pros and cons of the imaging examination options, and making it difficult to monitor the fulfillment and appropriateness of the recommendation.”
The authors suggested that, in order for a closed loop communication tool to be truly effective, it will likely require a “forcing function” to ensure completeness.
To learn more about this study, click 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.