Patient Interaction Revamped
Residents at Indiana University School of Medicine get out of the reading room to deliver patient results in person.
"If someone would have just come in here and told me my ultrasound was negative, I would have doubted them or not believed them. To go through the images and have everything explained shows me that the test is truly normal and there is someone dedicated to looking at every image." — Ms. C (a patient who participated in a radiologist consultation)
Millions of studies are ordered from the ED every year across the United States. How many patients have a similar experience to this one? A conversation that only takes a few minutes may have a lasting impact on the patient’s experience in the emergency department. So who is responsible? It is certainly not the emergency medicine physician, who is likely overworked, understaffed, and not trained in medical imaging and interpretation.
Imaging 3.0 aims to position radiologists as expert consultants to referring physicians and health systems, while empowering and informing patients and providers to improve efficiency and quality of care. One way to accomplish these goals is to position radiologists as consultants in the ED, making us available to deliver imaging results directly to patients and consult with ordering providers via face-to-face communication.
I had the opportunity to spend a month working as a consultative radiologist in the ED, working directly with ordering physicians and patients to improve the quality of care. When a patient received a cross-sectional imaging study, I would deliver the results to the ordering physician, learn the disposition of the patient, and deliver the results to the patient at bedside.
It might sound daunting, but explaining the imaging findings with an iPad was simple and straightforward. The median time to do so was only 5.6 minutes per patient. Not surprisingly, patients loved getting to see their imaging findings and actually learned what a radiologist does. In fact, before the consultation, 15 percent of patients correctly identified a radiologist as a doctor specializing in medical imaging and interpretation. After meeting with the radiologist, these numbers improved to 73 percent. Patients overwhelmingly said reviewing imaging findings with a radiologist improved their overall satisfaction. They indicated they would be more likely to choose our hospital as a result of this radiologist consultation model.
The reaction from ordering physicians in the ED was similar. Many were shocked to see a radiologist out of the reading room and thrilled at the opportunity to interact on a personal level. They overwhelmingly agreed the presence of a radiologist in the ED improved their working relationship with the radiology department. Although ED physicians do not believe the presence of a radiologist disrupted their workflow, some were concerned a radiologist may provide inaccurate or conflicting recommendations.
Not every institution is set up to seamlessly integrate a similar consultation model, but a few key steps will go a long way.
•Identify an emergency medicine physician who will be an advocate and keeping them involved every step of the way.
•Address the concerns from the ED perspective and make it clear you will only deliver imaging results or discuss the patient disposition after you have had a chance to talk with the ordering physician.
•Practice how you will introduce yourself to the patient and explain what a radiologist does.
•Do the same regarding imaging findings. If you can’t explain how a CT or ultrasound works to a friend without a medical background, the average ED patient won’t understand either.
•Consider how you present the images. We are used to the axial plane, but the coronal plane or sagittal plane may be more intuitive to a patient with no medical background.
•Expect to be challenged by staff who think the only job of a radiologist is to crank out RVUs, and use this as an opportunity to educate your colleagues about Imaging 3.0.
The most ideal situation to implement this consultative model is using upper-level residents during 4th-year elective time. Unfortunately, not all programs will support this type of clinical endeavor. Many ED radiology sections will not tolerate losing an upper-level resident to deliver findings to patients. If this is the case, start small with a few interactions a day and make sure to emphasize the positive impact this will have on our patients and referring physicians.
By William Kerridge, MD, department of radiology and imaging sciences at Indiana University School of Medicine