Survey of radiologists and emergency department providers after implementation of a global radiology report categorization system.

PURPOSE: Breakdown in communication of important imaging results threatens patient safety and risks malpractice claims. To facilitate closed-loop communication, our institution developed a unique radiology report categorization (RADCAT) system employing automated alert notification systems. This study aimed to understand users' initial experiences with the RADCAT system and obtain feedback. METHODS: Web-based surveys were distributed to radiologists and emergency department (ED) providers at our hospital system within 1 year of institution-wide RADCAT implementation. Survey designs differed based on clinical setting. Most prompts utilized declarative statements with 5-point agreement Likert scales. Closed-response data was analyzed with descriptive statistics. RESULTS: Response rates among radiologists and ED providers were 59.4% (63/106) and 38.4% (69/211), respectively. 78.0% (46/59) of radiologists and 60.9% (42/69) of ED providers agreed that RADCAT improves patient care. Of radiologists, 84.1% (53/63) agreed that RADCAT design is intuitive, and 57.6% (34/59) agreed that RADCAT improves efficiency. Of ED providers, 69.6% (48/69) agreed that RADCAT appropriately differentiates urgent and non-urgent findings, and 65.2% (45/69) agreed that auto-population of discharge documents with imaging results containing follow-up recommendations protects them from liability. Only 35.6% (21/59) of radiologists and 21.7% (15/69) of ED providers agreed that RADCAT implementation decreased reading room visits by ordering providers. Open-response feedback showed that some ED providers find RADCAT too complex while some radiologists desire improved transparency regarding imaging study communication status. CONCLUSION: Since its implementation, RADCAT has been well received among radiologists and ED providers with agreement that it improves patient care and effectively distinguishes and communicates important imaging findings.

Implementation and Impact of a Comprehensive Radiology Report Categorization System on Communication of Important Results.

PURPOSE: Effective communication of important imaging results is critical to patient care but difficult to accomplish efficiently. To improve communication at their institution, the authors introduced a radiology report categorization system (RADCAT) that organizes diagnostic imaging reports and uses automated communication systems. The study objectives were to (1) describe RADCAT's design, (2) evaluate its implementation for appropriate imaging, and (3) evaluate the communication of important, nonurgent results with recommended follow-up. METHODS: This retrospective study was performed in a multihospital adult and pediatric tertiary referral academic health system. The intervention, a radiology report categorization system with five levels of acuity and IT-supported communication workflows, was globally implemented in November 2017. The primary outcomes were the successful implementation of RADCAT to appropriate diagnostic imaging reports and the successful communication of important, nonurgent results with recommended follow-up to ordering providers and patients by the radiology quality assurance team. RESULTS: Over 18 months after implementation, 740,625 radiology reports were categorized under the RADCAT system, with 42%, 28%, and 30% from the emergency department, inpatient, and outpatient settings, respectively. A random selection of 100 studies from the 23,718 total reports without RADCAT categorization identified 4 diagnostic radiology reports that erroneously lacked RADCAT grading. In 2019, of the 38,701 studies with nonurgent imaging follow-up recommendations, 38,692 (nearly 100.0%) were successfully communicated to providers or patients on the basis of quality assurance data. CONCLUSIONS: A comprehensive radiology report categorization system was successfully implemented across a multihospital adult and pediatric health system, demonstrating reliable communication of imaging results with recommendations for nonacute imaging follow-up.

Efficacy of Computed Tomography Utilization in the Assessment of Acute Traumatic Brain Injury in Adult and Pediatric Emergency Department Patients.

BACKGROUND: Computed tomography (CT) is commonly used to assess traumatic brain injury (TBI) in the emergency department (ED). Radiologists at a Level 1 trauma center implemented a novel tool, the RADiology CATegorization (RADCAT) system, to communicate injuries to clinicians in real time. Using this categorization system, we aimed to determine the rates of positive head CTs among pediatric and adult ED patients evaluated for TBI. METHODS: We performed a retrospective analysis of all patients who received a head CT to assess for TBI. We classified head CTs using the RADCAT tool. On a 5-point scale, scores of 3 or less are considered normal or routine. Scores of 4-5 are considered high priority, representing findings such as intracranial bleeding. RESULTS: Of the 5,341 head CT's obtained during the study period, 992 (18.5%) had high priority results (scores 4-5). A large number of pediatric studies, 30.8%, were positive for high priority results. Among the adult population, 18.0 % contained high priority results. CONCLUSION: The pediatric population had a higher rate of high priority reads among those undergoing non- contrast head CT for TBI compared to adult patients.

Automated Delivery of Clinical Follow-Up to the Radiologist via E-Mail: Feasibility Study of a New Information Technology Algorithm.

OBJECTIVE: The purposes of this study were to develop an automated process for radiologists to obtain clinical follow-up on radiology reports via HIPAA-compliant e-mail and to determine what follow-up data were collected and whether they were relevant to the radiology reports. CONCLUSION: The algorithm generated high-yield follow-up data for radiologists that may improve patient care by facilitating radiologist engagement and self-assessment.

Pilot study of a new comprehensive radiology report categorization (RADCAT) system in the emergency department.

PURPOSE: The purpose of this study was to describe a new, broadly applicable radiology report categorization (RADCAT) system that was developed collaboratively between radiologists and emergency department (ED) physicians, and to establish its usability and performance by interobserver variation. METHODS: In collaboration with our ED colleagues, we developed the RADCAT system for all imaging studies performed in our level-1 trauma center, including five categories that span the spectrum of normal through emergent life-threatening findings. During a pilot phase, four radiologists used the system real-time to categorize a minimum of 400 reports in the ED. From this pool of categorized studies, 58 reports were then selected semi-randomly, de-identified, stripped of their original categorization, and recategorized based on the narrative radiology report by 12 individual reviewers (6 radiologists, and 6 ED physicians). Interobserver variation between all reviewers, radiologists only, and ED physicians only was calculated using Cohen's Kappa statistic and Kendall's coefficient of concordance. RESULTS: Altogether, agreement among radiologists and ED physicians was substantial (κ = 0.73, p < 0.0001) and agreement for each category was substantial (all κ > 0.60, p < 0.0001). The lowest agreement was observed with RADCAT-3 (κ > 0.61, p < 0.0001) and the highest agreement with RADCAT-1 (κ > 0.85, p < 0.0001). A high trend in agreement was observed for radiologists and ED physicians and their combination (all W > 0.90, p < 0.0001). CONCLUSIONS: Our RADCAT system is understandable between radiologists and ED physicians for categorizing a wide range of imaging studies, and warrants further assessment and validation. Based upon these pilot results, we plan to adopt this RADCAT scheme and further assess its performance.

The RADCAT-3 system for closing the loop on important non-urgent radiology findings: a multidisciplinary system-wide approach.

The goal of this project was to create a system that was easy for radiologists to use and that could reliably identify, communicate, and track communication of important but non-urgent radiology findings to providers and patients. Prior to 2012, our workflow for communicating important non-urgent diagnostic imaging results was cumbersome, rarely used by our radiologists, and resulted in delays in report turnaround time. In 2012, we developed a new system to communicate important non-urgent findings (the RADiology CATegorization 3 (RADCAT-3) system) that was easy for radiologists to use and documented communication of results in the electronic medical record. To evaluate the performance of the new system, we reviewed our radiology reports before (June 2011-June 2012) and after (June 2012-June 2014) the implementation of the new system to compare utilization by the radiologists and success in communicating these findings. During the 12 months prior to implementation, 250 radiology reports (0.06 % of all reports) entered our workflow for communicating important non-urgent findings. One-hundred percent were successfully communicated. During the 24 months after implementation, 13,158 radiology reports (1.4 % of all reports) entered our new RADCAT-3 workflow (3995 (0.8 % of all reports) during year 1 and 9163 (1.9 % of all reports) during year 2). 99.7 % of those reports were successfully communicated. We created a reliable system to ensure communication of important but non-urgent findings with providers and/or patients and to document that communication in the electronic medical record. The rapid adoption of the new system by radiologists suggests that they found it easy to use and had confidence in its integrity. This system has the potential to improve patient care by improving the likelihood of appropriate follow-up for important non-urgent findings that could become life threatening.

Administration of subcutaneous buffered lidocaine prior to breast lymphoscintigraphy reduces pain without decreasing lymph node visualization.

UNLABELLED: Breast lymphoscintigraphy using (99m)Tc-sulfur colloid ((99m)Tc-SC) is well established in clinical practice for staging patients with breast carcinoma. Nearly all patients report having pain during the procedure. However, techniques used to minimize pain during breast lymphoscintigraphy are highly variable across institutions. Our study was to determine whether anesthetizing the skin with sodium bicarbonatehether-buffered lidocaine before performing breast lymphoscintigraphy reduced the pain experienced by the patients. The second objective of this study was to evaluate whether anesthetizing the skin with buffered lidocaine changed visualization of lymph nodes. METHODS: This prospective, patient-masked and randomized study involved performing breast lymphoscintigraphy in a control group and experimental group of female breast cancer patients. The control group did not receive skin anesthetic before (99m)Tc-SC injections, whereas the experimental group first underwent skin anesthesia with an injection of 2% sodium bicarbonate-buffered lidocaine. All patients were asked to rate their pain levels, using the National Institutes of Health pain scale, before the procedure and immediately after the injections. The change in pain from baseline was compared between the 2 groups. After the injections, scintigraphic imaging of the axilla was performed, and the number of axillary lymph nodes visualized was recorded. RESULTS: No significant difference was found in preprocedural baseline pain from the control group, compared with the experimental group. There was a statistically significant difference in the increase in pain experienced during the procedure between the control group and the experimental group (P = 0.009). There was no significant difference in the detection of lymph nodes between the control and experimental groups (P = 0.56). CONCLUSION: The results from our study indicate that injecting subcutaneous buffered lidocaine before intradermal injection of (99m)Tc-SC for breast lymphoscintigraphy significantly decreases patient pain without interfering with lymph node visualization.

Review of outside studies by radiology residents: national survey of chief residents.

The purpose of this study was to establish practice patterns of radiology residents in regards to interpretation and reporting of outside studies for transferred patients. We performed a national survey of radiology residency chief residents, administered by email through the Association of Program Directors in Radiology (APDR). There were 81 chief resident respondents, representing 42.8 % of 187 total Accreditation Council for Graduate Medical Education (ACGME)-approved radiology residency training programs in the USA. In 97.5 % of programs, residents perform interpretations of outside studies. Up to 76.7 % of respondents state that when outside studies are reviewed by residents, an original report is available in less than one quarter of cases. While 55.1 % of respondents state that there is a mechanism for recording their findings and impressions for outside studies, only 32.1 % are aware of a policy requiring documentation. Of the respondents, 42.3 % report they have no means for documenting their findings and impressions on outside studies. Further, 65.4 % state that there is no policy requiring an attending to review and document agreement with their interpretation of outside studies. There is wide institutional variation in both policy and practice regarding reinterpretation of outside studies for patients transferred to academic hospitals. While the majority of radiology residents are providing the service of reinterpreting outside studies, only a minority of residency programs have a policy requiring (1) documentation of their impressions or (2) attending oversight and documentation of discrepant opinions.

Multiinstitutional computer database for recording nonvascular imaging-guided interventions.

OBJECTIVE: We sought to describe a multiinstitutional database created for tracking CT and sonographically guided interventional procedures. CONCLUSION: The database, created using commercially available software, has been placed on the secure hospital internal network for easy access from two institutions. More than 1,000 separate interventions have been added. The data may be queried and filtered for quality assurance and research purposes.