Even In Serious Cases, Many Radiology Recommendations Are Simply Not Followed

The importance of improving communication skills to keep radiology recommendations from falling to the wayside

One-third of radiology recommendations — including those that deal with serious health concerns — are not followed, according to a recent study. In fact, 39% of the non-followed recommendations were not even acknowledged as being received.

Proper communication between healthcare professionals is an essential part of effective patient care. However, when communication lapses occur, quality of care can potentially suffer. Oftentimes, the recommendations offered by radiologists deal with critical issues, and when these recommendations simply fall to the wayside, the patient ultimately deals with the potential health consequences.

In order to ensure that radiology recommendations are followed up on when it matters, healthcare providers need to revamp their digital communication resources, work with healthcare professionals to improve their interpersonal communication skills, embrace a more interdisciplinary approach, and educate patients on the importance of being involved in their own healthcare dialogue.

Types of Unacknowledged Recommendations

Alexander Norbash, MD, with the University of San Diego, worked with a team to review 6,851 patient reports which the Boston Medical Center pulled together in January 2014. Of all the patient reports, the team found that 13% (857) featured one or more radiology recommendations. The recommendations ran the gamut: of the 972 recommendations, 63% dealt with a need for additional imaging, 24% called for clinical correlation, 7% were related to a non-imaging procedure, and only 4% dealt with a laboratory study. The team noted that receiving physicians followed 650 of the recommendations (67%); however, one-third of the recommendations weren’t followed, and 127 recommendations (39%) weren’t even noted as being received. Also, 61% of the not-followed recommendations were documented as being received, but they were not followed for a number of different reasons, including patients not being involved in the procedure, the recommendations were no longer relevant medically, or the physicians simply didn’t agree with the recommendations in the first place.

In terms of the recommendations that weren’t acknowledged, nearly half (43%) dealt with a serious concern. For example, 42 were tied to a concern about cancer, and 20% dealt with follow-up requests regarding lung nodules. Study investigator Nadja Kadom, MD, with Emory University in Atlanta pointed out that it’s important to remember that some recommendations, even critical ones, can sometimes be misplaced or lost — a fax might fail to go through, or a receiving physician might not notice that they’ve received an electronic message or e-mail. Healthcare providers can work on improving their internal communication efforts in order to limit the amount of recommendations that fail to be either sent or received.

How to Ensure Recommendations are Received

Text messaging systems, patient portals or instant messaging platforms can all be used to boost the reliability of internal communication efforts — many of these modern digital tools allow for message tracking, which can help to ensure that messages are properly and promptly delivered.

However, technology aside, healthcare providers can help to guarantee that recommendations are at least received and acknowledged at a greater rate by working on including patients in the discussion, and by also improving interpersonal communication efforts between healthcare professionals. These are key lessons that are also important to emphasize at the educational level, which we strive to do at the University of Cincinnati radiology program where I teach.

For example, radiology professionals and physicians can agree to jointly sign off on procedures when the radiologists offer critical health recommendations. Or, radiologists can use digital tools — such as video conferencing — to check in with physicians face-to-face about particularly demanding cases. Most importantly, though, is that providers need to work to include patients within the healthcare dialogue. Oftentimes, patients simply wait for healthcare professionals to reach out to them with results, requests, or guidance. However, in some cases, it’s entirely acceptable for patients to contact their providers to check in on an ongoing diagnosis or upcoming procedure. Additionally, by posting radiology recommendations or concerns to a patient portal, patients can be brought into the loop, helping to catch any recommendations that might relate to serious issues (such as those dealing with cancer).

In short, when it comes to high quality patient care, efficient and thorough communication is vital. In order to help reduce the amount of radiology recommendations that simply fall to the wayside, healthcare providers need to work on not only improving their communication tools, but also on refining physicians interpersonal communication skills, and pushing patients to get involved in healthcare discussions.