Radiology recommendations are frequently ignored, study finds

Better information technology may help

Nearly one-third of radiology results that call for further clinical action are not acted upon, according to a retrospective study of patient records, Damian McNamara reports for Medscape.

For the study, presented at the American Roentgen Ray Society 2016 Annual Meeting, researchers reviewed more than 6,800 patient reports generated at a large Massachusetts medical center in January 2014. The researchers identified 857 reports that included 972 radiological recommendations, of which:

  • 63 percent recommended additional imaging;
  • 24 percent called for clinical correlation;
  • 7 percent advised a non-imaging procedure;
  • 4 percent dealt with laboratory tests; and
  • 2 percent related to consultations with specialists.

Next, researchers examined patient charts to determine rates of follow-through. Overall, just 67 percent of the radiology recommendations were followed.

Of the recommendations that were not followed, 61 percent were documented in a referring doctor's notes but not accepted by the doctor, no longer considered clinically relevant, or lost to follow up.

Of the remaining 39 percent of recommendations that were not documented, the researchers identified 43 percent as significant, including several relating to cancer concerns, such as lung nodules requiring follow-up.

Lessons for Strengthening the Hospital-Radiologist Relationship

Alexander Norbash, a study investigator from the University of San Diego, says it is concerning that so many recommendations were not followed. "We found 55 patients in one month; that adds up over a year," he notes. Study investigator Nadja Kadom, from Emory University, says the takeaway for providers is that they cannot assume that referring doctors will always follow recommendations.

But the study authors say there are ways providers can improve, such as using:

  • Dedicated radiology staff;
  • Patient navigators; and
  • Modern information technology systems.

"These solutions may seem costly, but health enterprises need to weigh the cost of medicolegal actions from missed cancers or other adverse outcomes against the cost of investing in preventive measures," Kadom explains (McNamara, Medscape, 4/21).


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