Big benefits by radiologist review of—and consultation over—imaging orders

Giving radiologists more of a say in accepting, rejecting or changing referrers’ high-end imaging orders can significantly lift patient safety, cut costs and right-size resource allocation, according to a study conducted at Wilmington, Del.-based Christiana Care Health System and published online June 18 in the Journal of the American College of Radiology.

Biostatistician Bailey Ingraham, MS, radiology chair Kert Anzilotti, MD, MBA, and colleagues at the Jefferson University affiliate reviewed a radiology-initiated program piloted in Christiana’s coordinated care network.  

Under the program, the rads reviewed and regulated high-end imaging orders as part of the consult process with referrers.

For the purposes of the study, the research team defined high-end imaging as outpatient CT and MRI orders requested and performed—or not—within the Christiana network.

To evaluate the orders and their end results, the team used a standardized workflow and software tools incorporating ACR and Choosing Wisely criteria as well as a proprietary radiation-dose component.

Some 26 radiologists reviewed 2,177 high-end orders placed between July 2014 and August 2015.  

The researchers found that the rads approved 1,887 of these orders (86.7 percent), rejected 87 (4.0 percent) and recommended an alternate exam for 203 (9.3 percent).

In the authors report, just 1 percent of the exams (30 of 2,177) saw the ordering physician disagree with recommendations following consultation with the radiologist and still pursue the examination to completion.

Overall, this process prevented or altered 13.3 percent of high-end images completed over the fiscal year owing to their excessive or inappropriate characteristics.

In addition, the average time from order request to resolution was seven hours, 36 minutes.

“More than half the requests were resolved within two hours, regardless of whether or not cases were carried over the weekend,” the authors write, “and 80 percent of cases were resolved within 12 hours of the order’s being placed.”

Basing on their evaluation of the attainment of improved patient safety, cost savings and appropriate resource use, Ingraham et al. conclude from these findings that radiologists’ review can effectively reduce excessive high-end imaging utilization.

The authors summarize their key takeaway points as follows:

• Reviewing of outpatient high-end images by in-house radiology staff is a simple, cost-efficient way to reduce excess [high-end imaging utilization] with minor hindrance to ordering physicians.
• This type of role encourages education and collaboration between physicians and the radiology staff, as well as being an active way for radiologists to positively influence patients’ quality of care.
• Similar alternatives to [radiology benefit management] should be explored to reduce waste in health care spending, increase value in patient care and reduce providers’ time spent in excess bureaucratic processes.

“The movement from volume to value is an opportunity for radiologists to give new purpose to their profession, significantly contributing to the quality and safety of care,” Ingraham and co-authors write. “This refinement allows care providers, including the ordering physicians and radiologists, to focus on high-quality care fitting with Choosing Wisely’s mantra of ‘Right Test, Right Patient, Right Time, Right Cost,’ without having to worry about preauthorization and a burdensome bureaucratic process.”