Big news for radiologists: Providers taught how to place more effective imaging orders

Physicians frequently leave out key information when ordering imaging examinations, an oversight that can make it harder for the radiologist to do their job. A team of researchers worked to reverse that trend, sharing its findings in a new study published in the American Journal of Roentgenology.

“Radiologists are more likely to provide high-value imaging interpretations when ordering providers submit high-quality imaging histories at order entry,” wrote Daniel S. Bor, of Kaiser Permanente Colorado in Denver, and colleagues. “Various authors have reported strategies aiming to improve the quality of provided histories, including training technologists to interview patients, improving communication with referring providers, and improving information systems. However, to our knowledge, no studies have shown a sustained improvement in the quality of histories provided directly by ordering providers.”

The team began its quality improvement project by determining what, exactly, was needed for an imaging history to be considered complete. A radiologist, primary care physician, primary care physician assistant, IT consultant, medical imaging compliance officer, data analyst and process improvement consultant were all brought in to discuss this topic, with nurses and medical assistants brought in for further discussion.

The final verdict was that a complete imaging history required four things:  

  1. What happened
  2. When it happened
  3. Where the patient was experiencing pain
  4. The ordering provider’s concern

This finalized definition was then shared throughout the facility, giving everyone involved time to understand what was expected when orders for imaging examinations are placed. And two months later, Bor et al. began the study’s implementation phase by changing the electronic medical record (EMR) to prompt ordering providers to add the information associated with each component of the complete imaging history.

The imaging history of every fifth consecutive imaging examination was then tracked, with the researchers documenting if it contained a complete imaging history or lacked any of the requested information.

Overall, the team found that 16% of all orders placed before implementation contained all four components of a complete imaging history. After implementation, however, that number jumped all the way to 52%. In addition, the mean number of characters being entered into the patient’s imaging history increased from 45.4 prior to implementation and 75.4 after.

“We have reported an approach that makes a significant improvement to the frequent and long-standing challenge of sustainably improving the quality of patient history information submitted directly by providers who evaluate the patient and seek diagnostic imaging,” the authors wrote. “The frequency of more complete histories submitted after intervention increased by 225%, and the improvement was sustained for 18 months.”

Bor and colleagues contributed a lot of their team’s success to the fact that they brought in as many different voices as possible, engaging a variety of parties and working to get everyone on the same page.

“Recognizing the interdisciplinary nature of low-quality history information, we elicited the support of motivated ordering providers at the outset of this improvement project,” the authors wrote. “We educated them about the radiologist's perspective, including the value of complete imaging histories in ensuring high-quality imaging for their patients. We elicited their perspectives and preferred improvement strategies. We partnered with them over several months to collaboratively create a definition of a complete imaging history that resonated with their training, experience providing patient care, and workflows that also achieved the goal of improving the information sought by radiologists.”

This quality improvement projects, the team added, has made a noticeable impact. Radiologists say they have been able to make difficult diagnoses thanks to the change, for instance, and the authors said they have noticed “radiologists feeling less of a need to recommend additional downstream or repeat imaging.”