5 strategies to maintain radiology practice value in the face of increasing imaging volume

Numerous forces are combining to spike radiology practices’ imaging case volume, which could lead to low-quality care, errors and physician burnout.

Those drivers include a U.S. population that’s both growing and aging, ballooning use of imaging services, providers over-ordering services to avoid malpractice lawsuits and gaps in medical evidence. In a new analysis published Monday, several radiology experts shared a few steps that leaders can take to stem such trends.

“Radiologists are now facing a dilemma: They need to meet the requirements of value-based care while at the same time coping with ever increasing study volumes,” Abhimanyu Aggarwal, MD, a radiology resident at Eastern Virginia Medical School, wrote March 2 in Current Problems in Diagnostic Radiology.

“While targeting some of the aforementioned drivers of imaging utilization is outside the radiologist's scope, there are several strategies accessible to radiologists that can help with controlling or managing high study volumes while maintaining or improving value,” added Aggarwal and coauthors from five other institutions.

Those solutions include:

1) Utilizing imaging appropriately: There are numerous well-established measures to limit unnecessary scans. Educating providers on evidence-based practice guidelines, deploying computerized clinical decision-support systems, or using residents as consultants to answer radiologists’ questions are just a few, the team wrote.

2) Abbreviating MRI protocols: Previous studies have shown that shortening scan time can improve throughput without sacrificing image quality. Doing so has other spillover benefits, too, such as lessening the radiologists’ workload and shortening inpatient stays, Aggarwal et al. wrote. Another study also found that abbreviated MRI in pediatric radiology helped reduce the use of sedation.

3) Providing 24/7 coverage: Using round-the-clock, in-house attending coverage from radiologists has also been proven to help reduce turnaround times, in addition to bolstering emergency department workflow and quality of care. However, this strategy may be challenging for some, given the added cost and lack of trainee independence, the authors noted.

4) Communicating results efficiently: Oftentimes, radiologists need to directly share urgent test results with ordering providers. Certain barriers may prevent this from happening, but there are several solutions out there: flagging the results in the electronic system, using ancillary staff to close the care loop, or hiring a dedicated reading room assistant.

5) Preventing radiologist burnout: Potential strategies might include building resilience among staff, practicing mindfulness or addressing some of the root causes of physician fatigue (lack of autonomy, workflow inefficiency, clerical burdens, etcetera).

“Radiologists working long hours or off-hour shifts with a high volume of studies or complex studies are at the greatest risk of mental fatigue, which may lead to unconscious at-risk behavior by taking shortcuts in cognitive processes resulting in poor judgement and diagnostic errors,” the team wrote.