Factors affecting patient compliance in the acute setting: an analysis of 20,000 imaging reports.

The aim of this study was to identify the risk factors associated with noncompliance of recommendations made by emergency radiologists. Between March 2012 and August 2012, our team retrospectively reviewed 20,000 consecutive emergency department (ED) patients receiving imaging to assess how often emergency radiologists made recommendations, how often they were followed, and what factors were associated with noncompliance. Faculty (Radiology or Emergency Medicine) were considered senior if they had been practicing for >5 years post residency/fellowship training. Faculty practicing <5 years were considered junior physicians. The following data was extracted from the electronic medical records and the hospital information system: recommendation in imaging report, age, gender, race (Caucasian, African-American, and others), insurance status, primary care contact, distance from the hospital to patient residence, and primary language. Recommendations were categorized as follows: (1) immediate follow-up, (2) follow-up 1-4 weeks, (3) follow-up 1-3 months, (4) follow-up 4-6 months, (5) follow-up 7-12 months, and (6) clinical/laboratory follow-up recommendations irrespective of time. We identified 1,650 recommendations (1,650/20,000 = 8.25 %). Using a one-to-one logistic regression analysis, the following factors were significant (P < 0.05) when evaluating noncompliance: increasing age, no primary care physician, lack of insurance, primary language other than English, increased distance from hospital, and extended follow-up interval. Noncompliance with recommended additional imaging (RAI) is multifactorial. Primary and/or referring physicians should take notice of the aforementioned compliance trends and mitigating factors, adopt systematic safety measures and create interdepartmental dialogue with radiology to ensure compliance, and counsel and educate patients about the importance of imaging recommendations.

The diagnostic utility of rib series in assessing rib fractures.

Rib series rarely add information to the posteroanterior (PA) film for the diagnosis of rib fractures. In this investigation, we evaluated the utility of rib X-rays using turnaround time (TAT), radiation exposure, and cost-efficiency as the key parameters. This investigation was conducted from January 2008 to December 2012. We included patients who had rib series performed for suspected rib fractures. TAT for patients was calculated from the time exam was ordered by the emergency department (ED) physician/staff to time the report was finalized by the attending radiologist. Effective radiation dose for rib series was calculated as a summation of radiation dose from the standard rib series images for each patient. Cost-efficiency was determined based on the number of interventions that took place as a result of a complicated study. Our investigation consisted of 422 patients, 208 females aged (57 ± 20.8) and 214 males aged (48 ± 17.3). A total of 74(17.5 %) abnormal findings were noted, out of which only 1(0.23 %) underwent management change. The mean turnaround time for patients undergoing rib series had a value of 133.5 (±129.8) min as opposed to a single chest PA of 61.8(± 64) min. Average effective radiation dose for a rib series was 0.105 (±0.04) mSv, whereas average effective radiation dose of a single chest PA was 0.02 mSv. Dedicated rib series has a low-yield diagnostic value as it pertains to management change. The overall impact on patient care based on our findings is small when compared to the risks associated with prolonged TAT, repeated exposure to radiation, and extensive medical costs.