Communication improves and radiologists benefit from a higher profile with referring clinicians in healthcare facilities equipped with embedded reading rooms, new research shows.
In the era of PACS, fewer opportunities exist for radiologists to interact face to face with their clinician colleagues. To that end, some healthcare facilities have embedded radiology reading rooms in clinical areas in hopes of improving direct communication between radiologists and referring physicians.
Allison Tillack, Ph.D., a fourth-year medical student at the University of California at San Francisco, and colleagues studied a large, tertiary care U.S. academic hospital to determine whether embedded radiology reading rooms are associated with increased rates of direct communication between radiologists and clinicians. Dr. Tillack’s research was funded by a 2011 Fujifilm Medical Systems/RSNA Research Medical Student Grant and later published in the May 2013 edition of the Journal of the American College of Radiology.
Dr. Tillack found a “highly significant positive correlation” between the location of the reading room and communication between clinicians and radiologists. Embedded reading rooms offer the best opportunity to maximize the correlation. Data showed more visits to embedded reading rooms by referring clinicians than to reading rooms located in another part of the facility.
“This could be the first quantitative study that shows radiologists integrate better with the remainder of our clinical colleagues if we are in a reading room that is embedded in their clinical service,” said James Borgstede, M.D., vice-chair of the radiology department at the University of Colorado at Denver and Dr. Tillack’s scientific advisor and co-author of the study. Dr. Borgstede chairs the RSNA Research & Education (R&E) Foundation Board of Trustees.
“The type, quality and length of communication all seem to be more appropriate when radiologists are in close contact geographically with their clinical colleagues,” Dr. Borgstede added.
The facility in the study featured two embedded reading rooms (breast and musculoskeletal) and two non-embedded reading rooms (body and neuroradiologic imaging) located in the hospital’s basement.
Dr. Tillack gathered data on frequency, form (telephone, in-person visits and via Veriphy, a Joint Commission-recommended system for communicating critical test results), duration and general purpose of communications. Over eight weeks, she examined communications and collected 175 incidents, 100 of which came from embedded reading rooms.
In-person visits to the embedded breast and musculoskeletal reading rooms dramatically outpaced those to the non-embedded body and neuroradiology reading rooms (46 percent versus 7 percent), while non-embedded reading rooms had a higher rate of Veriphy use than embedded reading rooms (40 percent versus 7 percent).
“This was a highly significant difference, but we couldn’t say for sure that it was caused only by the location difference,” Dr. Tillack said. “It’s certainly one of the hypotheses, and I think a very likely one, but we had to factor in the nature of different reading room work as well as culture. We couldn’t say for sure that this wasn’t just a particularly pro-interactive group of orthopedic surgeons or musculoskeletal radiologists, for instance.”
Dr. Tillack noted that the musculoskeletal reading room was located directly across the hall from the orthopedic surgery dictation room while the Rheumatology Department was just down the hall, making in-person visits very convenient. The reading room had no doors and clinicians were often seen stopping by to discuss cases.
“It was a very collegial, friendly atmosphere,” Dr. Tillack said. “Orthopedic surgeons we talked to were excited about the convenience and said it was great to be able to drop by and look at a case with the radiologist without having to go downstairs.”
The telephone was the most common form of communication regardless of the reading room locations. Also, there was no significant difference in the number of calls to embedded reading rooms (47 percent) and non-embedded ones (53 percent).
Dr. Tillack acknowledged that application of the study does have limitations, especially regarding multispecialty clinics and/or private practices. In multispecialty situations it becomes problematic to decide where the reading room would be embedded. In the case of abdominal radiologists, for example, it is difficult to decide if they should embed with gastroenterologists, nephrologists or urologists.
While the researchers admit the study was limited and said they hope to do further research in the area, they maintain the embedding provides value for those looking to improve communications and raise the profile of radiologists within their work environments.
“The important thing is that the concept is out there,” Dr. Borgstede said. “We’re in a different era than a generation ago when clinicians came to radiologists to look at film studies that could only be viewed in one place at a time. Now that’s not true. It’s a new paradigm and if they aren’t going to come to us, we have to go to them.”
Dr. Tillack credited the RSNA for awarding her the grant that made the study possible. “The RSNA grant was the inspiration for the project and allowed me to make the research happen,” she said. “Learning to develop a very targeted question, work it through, do the analysis and take it to publication is really a valuable and fantastic experience. Making those connections with my mentor and other people who helped in the research has also been so valuable.”
Name: Allison Tillack, Ph.D.
Grant Received: Fujifilm Medical Systems/RSNA Medical Student Grant
Study: “An Evaluation of the Impact of Clinically Embedded Reading Rooms on Radiologist-Clinician Communication”
Career Impact: “This grant has been an important step in working towards the goal of becoming an academic radiologist active in research,” Dr. Tillack said. “The experience I have gained in designing and implementing this project will be useful for the rest of my career. The excellent guidance I received while working on this project has enabled me not only to gain a better appreciation for the intricacies of careful data collection and analysis, but also provided me with outstanding role models for becoming both a researcher and a practicing radiologist.”
Clinical Implication: “This study indicates that locating radiology reading rooms in clinical areas results in more face-to-face interactions between radiologists and referring providers. Fostering better relationships and improved communication among healthcare professionals translates into improvements in patient care. Medical imaging has become a critical component of modern healthcare, and radiologists possess the skills, knowledge and expertise that ensure these powerful imaging technologies are used safely and appropriately.”
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