To resolve these issues, Araujo and his team coordinated with the radiology department’s information technology experts to develop a special EHR order for outside imaging consultations. Here’s how it works: When a clinician has a question about an outside imaging study, he or she calls the radiology department, and a radiology navigator — a team member who answers the phone and performs other administrative tasks in the imaging department — gets the appropriate consulting radiologist on the phone. (Read more about the radiology navigators at http://bit.ly/qualityassured .) After speaking with the consulting radiologist about the exam, the clinician fills out the consultation order in the EHR.
On the order, the clinician lists the consulting radiologist’s name and answers a set of questions regarding the consultation request. Once the consulting radiologist sees the order in the worklist, he or she opens the order and starts dictating the consult to specifically address the questions raised by the ordering clinician. The radiologist provides a final written consult, which is then transferred to the patient’s EHR, and a notification is sent to the ordering clinician.
“For example, the ED physicians might have a piece of paper or a preliminary read from the outside institution‘s CT scan that says, ‘This patient has acute diverticulitis,’ and they need us to confirm whether the patient really has acute non-complicated diverticulitis — that’s it,” explains Araujo, the radiology department’s quality and safety officer. “We still look at the entire imaging study, but focus on the most acute and urgent findings. If there is any clinically relevant incidental finding, a need for additional imaging, or recommendation for other modalities, we also address that in the consult.”
Since implementing the program in January of 2015, the radiology team has consulted on more than 200 cases in the adult and pediatric EDs and in the interdisciplinary tumor board conference with the transplant surgery department. On the tail of this success, it plans to expand the program to the rest of the hospital.
“We believe and intend to prove that a radiology consultant model will be fruitful and more patient-centered, resulting in improved, safer care and decreased cost, radiation exposure, and repeat imaging,” Araujo says. “This approach will unearth the value that radiology as a specialty contributes to the care of patients while increasing clinician satisfaction and helping to strengthen relationships with referring providers.”
Already, the program is having an impact on patient management, with early data indicating that the consultations change the course of care more than 10 percent of the time. “We’re consulting using the outside imaging, improving efficiency in patient care in the ED, and making recommendations that can change the course of care for patients,” Araujo explains. “We are providing more than image interpretation; we are providing medical advice on further imaging or clinical steps based on the conversation and outside imaging findings.”
In one case, for instance, a patient arrived at UMMC’s transplant center with an outside MRI report showing multiple liver lesions suspicious for multifocal liver cancer, but a radiology consultation with a dedicated body radiologist revealed that the patient had cirrhosis, multiple regenerative nodules, and confluent hepatic fibrosis — but no cancer. In line with those findings, the patient was put on a routine screening schedule to monitor his condition without the need for cancer treatment.
Kolb says the program has made it much easier to consult radiologists in such cases, relieving a lot of pressure in the ED. “Instead of cobbling around and trying to get a radiologist to look at images off the record, we have a process for a formal consultation,” he says. “It gives us a concrete answer and a documented report in the chart to help us manage the patient better.”