5 October 2015

Aligning the Radiology Department with the Emergency Department

In emergency departments, high quality and timely care are the top priorities. To improve these metrics, radiologists can work collaboratively with emergency physicians by offering recommendations on imaging modalities and utilization. Since the emergency department is typically the heaviest user of radiology within a hospital - ordering, on average, 45 percent of all CT scans - improving radiologist-EM physician alignment and communication can have dramatic impact.

Benefits

Working to better align the radiology department with the ED has payoffs for all involved: physicians, patients and hospital leadership. When the two departments understand one another’s objectives, they can work together to build a workflow that meets each other’s needs.

A streamlined workflow cuts down on time spent locating pertinent clinical information and ensures the best imaging modality has been chosen to address the questions of the referring physician. This time saved, in turn, cuts down on the patient’s wait time — improving his or her experience in the ED — and improves the turnaround time of studies allowing EM physicians to act quickly with the results of the imaging test.

Improving communication between radiologists and EM physicians can cut down on costly emergent imaging that may be unnecessary during the ED visit. Roughly eight percent of patients who receive high-tech imaging in the ED are sent home before their test results are even returned to the ordering physician, and as many as 16 percent of MRIs are ordered unnecessarily.

Fortunately, better radiology-ED integration is possible to achieve with relatively simple process improvements.

Strategies

First, radiologist should be supplied with access to patient EMRs, empowering them to review detailed provider notes & supplying them with clear indication for examination. Valuable radiology reports are not only accurate (getting the answer right), but also address the clinical question asked by the ordering physician (answering the right question). Access to real time patient records allows the radiologist access to a comprehensive recap of how the patient was injured, the location of pain, the physician’s specific concerns and other pertinent information, which enable radiologists to produce a useful report. Ambiguous or incomplete medical records may not allow the radiologist to appropriately address the reason for the exam or provide a definitive interpretation that is valuable to the ordering clinician. Providing an indication of a wet read can be helpful for both teams as well. Keeping an open exchange of communication and real time dialogue between the EM physician and radiologist regarding each of their study interpretations can ensure the most accurate final results are reported.

Second, establish a process to communicate critical findings. Certain imaging results require immediate attention from the EM physician. Critical life threating findings, such as brain hemorrhages, must be communicated as quickly and effectively as possible. A Kaizen event can be a breakthrough tool that helps leadership and front line workers from both departments to establish efficient, high performing communication processes. Critical results — those that require urgent action or are a major finding, like cancer — necessitate direct physician to physician voice communication from the radiologist to the emergency physician. Even when studies have a short turnaround time, critical results should be directly communicated via phone, video conferencing or in person to ensure appropriate delivery and response.

Lastly, use technology to make records accessible. Now that EHRs are ubiquitous, it is important to make sure they are configured in a way that makes it easy for radiologists to access relevant information. Radiologists should be able to see the patient’s current symptoms and his or her medical and surgical history. Radiology workflow technology can also facilitate the sharing of patient documents and information. To ensure the speediest care, referring physicians should still include all relevant notes in their indication for examination.

Conclusion

Until recently, hospital departments worked in silos, but there is a growing push to break down the barriers that insulate physicians into their own departments and specialties. Increasingly, clinicians are finding that working collaboratively, acting in a consultative capacity for their peers and sharing knowledge improve patient care and hospital efficiency. Encouraging dialogue between radiologists and emergency medicine clinicians helps build rapport and establish trust. When EM doctors view radiologists as teammates and advisors, radiologists have an opportunity to provide guidance during diagnosis and treatment planning, and also during test ordering, saving both time and money. Clear, effective communication can move radiologists from order takers to true consultants and collaborators.