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Avoiding backlogs, communication woes

Radiology Administrator's Compliance and Reimbursement Insider, December 1, 2007

Less-than-prompt service in the radiology department can compromise quality of care

Get the diagnosis set within a day.

That is the golden rule of Leonard Berlin, MD, FACR, for turnaround time for a patient undergoing tests in a radiology department.

“It is the general practice that all reports get out within about 24 hours at the latest,” says Berlin, professor of radiology at Rush University Medical College in Chicago. “Certainly, reports of urgent cases and emergency cases should be issued within an hour or even less.”

One hospital in Australia, however, missed the boat. In fact, some of its radiology department patients have gone several months without being diagnosed, according to The Sydney Morning Herald.

Now, a healthcare debate is raging at Liverpool Hospital in Sydney over two lung cancer patients whose x-ray results showed early signs of the disease but were not immediately reported to the referring doctors. One of the patients died.

“The nodule was reported and a report issued, but the doctor team that requested the report never saw the report,” Glen Schlaphoff, the director of radiology at Liverpool Hospital, told The Sydney Morning Herald.

Officials have since discovered the hospital had a backlog of 4,500 images that went unreported by a radiologist. The hospital uses a paper-based system for reporting scans.

An ‘unacceptable’ practice

“Having a backlog of 4,500 unread images is terrible, as is not issuing a radiology report until months after the person has passed through the emergency department [ED],” Berlin says. “This is unacceptable from any point of view. Certainly, it would not be tolerated in any U.S. hospital.”

The news has radiology officials in the United States stressing the need for prompt, organized, and efficient turnaround times for patients to prevent disasters. Radiology officials say the most important steps are to have strong communication between the radiologist and ordering physicians, and invest in the latest technology that expedites the transmitting process.

However, one radiologist feels the onus is also on the patient to get results.

“The duty of the patient is to know that a test was ordered, why, and ask the [physician] who got it, what the results were and what they mean,” says Michael Brant-Zawadzki, MD, FACR, medical director of radiology at Hoag Memorial Hospital Presbyterian in Newport Beach, CA. “ . . . When you take your car in to the mechanic or your dog in to the vet, do you not do that?”

Others say the responsibility lies fully with the radiologists and ordering physicians.

“ED imaging examinations should be read contemporaneously [while the patient is still in the ED], but at the very least, there needs to be an easy-to-use and completely [documented] method for reporting critical test results back to the ED and other referring sources,” says Steven M. Walter, MS, RT(R), director of imaging services at North Shore Medical Center in Salem, MA.

Go digital

Walter recommends the digital system that his facility uses for critical test result reporting. He says it’s a lifesaver for its quick turnaround.

North Shore Medical Center has used the system for more than a year, and it’s “one of the best investments in patient care that I have ever seen in radiology,” Walter says. “I can think of no significant pitfall or drawback to the system. While no system is perfect, this one is inestimably better than anything else I have seen.”

The system uses a color scheme to determine the level of urgency—red, orange, and yellow. Red represents the most urgent cases. Walter says the system can work as a “big risk management tool to reduce malpractice exposure.”

“This report is tracked to pickup by the referring MD or their designee, and this creates a document trail of the creation, delivery, and the recovery of the diagnosis,” he says. “In the case of the patient in [Australia], the findings may have been a yellow value [least critical] but would not have gone unreported for more than a few days before it would have been automatically flagged for administrative intervention. The system works equally well for critical results that require delivery to [a] referring source in less than one hour.”

Transparency, communication

But a computer can’t talk; a radiologist and referring physician must communicate, says Berlin.

“When there is a significant and unexpected finding on an x-ray study, it is the duty of the radiologist to expedite delivery of the report to the referring physician,” Berlin says. “This is usually done by telephone or in person. Unfortunately, we all know that written reports sometimes get lost or otherwise go astray. Hence, the direct communication practice guideline.”

Sometimes HIPAA gets in the way, says Brant-Zawadzki. He uses a hypothetical situation: “An emergency room physician orders a study, and the patient’s own physician does not know the patient visited the ER.” This problem cannot be solved, he says, unless community health records are available. But HIPAA makes that difficult.

Ultimately, no matter what the technology, it comes down to providing quality patient care—and each healthcare facility should take every step to ensure the best care, Walter says.

“Cases like that [in Australia] are rare, but they do happen,” he says. “Even cases with less tragic outcomes can have very unfavorable [effects] on patients, physicians, and hospitals.”

Insider sources

Leonard Berlin, MD, FACR, immediate past president of the Illinois Radiological Society and professor of radiology, Rush University Medical -College in Chicago, 9600 Gross Point Road, Skokie, IL 60076, 847/933-6111; Leonard_Berlin@rsh.net, www.illradsoc.org.

Michael Brant-Zawadzki, MD, FACR, radiology department medical director, Hoag Memorial Hospital Presbyterian, One Hoag Drive, P.O. Box 6100, Newport Beach, CA 92658-6100, 949/764-5942; mbrant@hoaghospital.org, www.hoaghospital.org.

Steven M. Walter, MS, RT(R), director of imaging services, North Shore Medical Center, 81 Highland Avenue, Salem, MA 01970, 978/354-4328; swalter@partners.org, http://nsmc.partners.org.

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