Radiologists’ Recommendations for Additional Imaging on Inpatient CT Studies: Do Referring Physicians Follow Them?
| Autor: | Owen Hanley Md, Janice Fitzgerald, Amir Lotfi, Jennifer Friderici, Tiara Sanborn Md, Poornima Manikantan, Mihaela S. Stefan, Linda Canty |
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| Rok vydání: | 2017 |
| Předmět: |
Adult
Male medicine.medical_specialty Cross-sectional study MEDLINE Referring Physician Article 030218 nuclear medicine & medical imaging Tertiary Care Centers 03 medical and health sciences 0302 clinical medicine Radiologists medicine Humans Practice Patterns Physicians' Referral and Consultation Pelvis Aged Inpatients business.industry Medical record General surgery General Medicine Odds ratio Middle Aged Confidence interval Cross-Sectional Studies medicine.anatomical_structure 030220 oncology & carcinogenesis Abdomen Female Tomography X-Ray Computed business |
| Zdroj: | Southern Medical Journal. 110:770-774 |
| ISSN: | 1541-8243 0038-4348 |
| DOI: | 10.14423/smj.0000000000000741 |
| Popis: | Objectives Studies have found that recommendations for additional imaging (RAI) accompany up to 31% of index computed tomography (CT) scans. In this study we assessed the frequency with which recommendations are accepted by the referring physician and the impact of AI on case management. Methods We performed a cross-sectional study of all index CT scans of the chest, abdomen, and pelvis performed on adult inpatients during a 1-month period at a tertiary medical center. Each radiology report was examined for mention of RAI. We used a standardized abstraction tool to review medical records for the indication for the RAI (related to original diagnosis vs incidental finding), the clinician's rationale for pursuing or discarding the RAI, and the impact of the AI on the inpatient treatment plan. Results Among the 430 scans reviewed, most (57.7%) were of the abdomen/pelvis. RAI was recommended in 67 cases (odds ratio [OR] 15.6%; 95% confidence interval [CI] 12.4-19.3) and AI was completed in 24 of 67 cases (35.8%). Factors associated with a recommendation for AI were the presence of an incidental finding (OR 3.5, 95% CI 1.7-6.8) and verbal communication of the result to the ordering provider (OR 2.09, 95% CI 1.23-3.5). When performed, AI altered the treatment plan 75% (18/24) of the time. Among the 43 cases in which AI was not performed, 34.1% were deferred to outpatient, 13.6% underwent alternative clinical intervention, and 13.6% were judged unnecessary by the primary team. No rationale was documented in the chart for the remaining 38.6%. Conclusions Despite concerns about autoreferral by radiologists for AI studies, we found a lower rate than in many prior studies, which may reflect a change in clinical practice. One-third of these recommendations were implemented and verbal communication was strongly associated with the likelihood of second image ordering. In the majority of the cases, the AI affected patient management. Based on these findings, radiologists should consider calling the ordering provider to increase the likelihood that the primary team will follow their recommendations. |
| Databáze: | OpenAIRE |
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