Lessons Learned: Radiology

And the results are …


Photo courtesy of Adrian Barnes

Photo courtesy of Adrian Barnes

The situation

When a patient undergoes radiology imaging, the expectation is that the ordering physician will read the radiologist’s report and follow up with the patient. The problem is, this communication doesn’t always occur.

“We have done root cause analyses looking at failure to communicate radiology findings,” said Susan Keating, director of clinical risk management for UF Health Shands Hospital. “Critical radiology results are typically followed up on successfully. It’s urgent and non-urgent findings that can slip through the cracks. Often the process of communicating these findings relies on multiple hand-offs between providers. A radiologist has to interpret the image and convey any significant findings to the ordering provider, who may or may not be the patient’s treating physician. From there, the ball can be dropped at multiple points before the patient is informed of the result.

“It’s a nationwide problem.”

The response

According to the American College of Radiology, up to 41 percent of patients are dissatisfied with the follow-up communication they receive (or do not receive) about imaging tests.

Of particular concern is failing to follow up on imaging tests that reveal the early signs of cancer. This occurs most commonly with lung cancer. Lung cancer develops slowly and can go undetected for years. A patient may undergo an X-ray in the E.R. for a chest infection that also shows early signs of lung cancer. The radiologist’s final report of a lung mass may come back after the patient is discharged from the E.R. If the patient’s treating physician is not informed of the test result, or doesn’t notice the test result after it was sent to him, the patient may never learn of it. The volume of radiology test results a physician receives can be quite large. Significant lab results, which have a numeric value, can be electronically flagged to the physician’s attention, but not free-text radiology reports.


The outcome

Unfortunately, hospital leaders usually become aware of the failed radiology result follow-up when the patient complains years later, after the cancer has progressed. To improve this process, the UF Health Shands Hospital radiology department devised a ranking system to assign each radiology report a value from 1 to 5, allowing significant radiology results to be flagged in EPIC. In addition, risk manages and quality reviewers are manually reviewing the charts of patients with incidental lung mass findings to confirm documentation of follow-up with patients. If there isn’t follow-up, the patients will be called directly.

“Instead of just ensuring the potential lung cancer finding reaches the doctor, now we are going to make sure it reaches the patient,” Keating said.