Analysis of Radiology Report Recommendation Characteristics and Rate of Recommended Action Performance.
Analysis of Radiology Report Recommendation Characteristics and Rate of Recommended Action Performance.
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DOI：
10.1001/jamanetworkopen.2022.22549
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发表时间：
2022-07-01
影响因子：
13.8
通讯作者：
Schiff, Gordon D.
中科院分区：
文献类型：
--
作者：
White, Tiantian;Aronson, Mark D.;Sternberg, Scot B.;Shafiq, Umber;Berkowitz, Seth J.;Benneyan, James;Phillips, Russell S.;Schiff, Gordon D.
What types of recommendations are contained in radiology reports, and how often are recommended follow-up actions carried out in the primary care setting? In this quality improvement study including 598 radiology reports at a single academic center, a taxonomy of recommended actions, time frames, and contingencies was developed. Application of this taxonomy showed that 1 of 7 recommendations were associated with failures to carry them out, and factors related to the report, patients, and clinicians were associated with successful vs unsuccessful follow-up. The findings of this study suggest that no follow-up on action-requiring abnormalities represents an important patient safety and malpractice risk; structured reports may help codify recommended actions and identify lack of follow-up. Following up on recommendations from radiologic findings is important for patient care, but frequently there are failures to carry out these recommendations. The lack of reliable systems to characterize and track completion of actionable radiology report recommendations poses an important patient safety challenge. To characterize actionable radiology recommendations and, using this taxonomy, track and understand rates of loop closure for radiology recommendations in a primary care setting. Radiology reports in a primary care clinic at a large academic center were redesigned to include actionable recommendations in a separate dedicated field. Manual review of all reports generated from imaging tests ordered between January 1 and December 31, 2018, by primary care physicians that contained actionable recommendations was performed. For this quality improvement study, a taxonomy system that conceptualized recommendations was developed based on 3 domains: (1) what is recommended (eg, repeat a test or perform a different test, specialty referral), (2) specified time frame in which to perform the recommended action, and (3) contingency language qualifying the recommendation. Using this framework, a 2-stage process was used to review patients’ records to classify recommendations and determine loop closure rates and factors associated with failure to complete recommended actions. Data analysis was conducted from April to July 2021. Radiology recommendations, time frames, and contingencies. Rates of carrying out vs not closing the loop on these recommendations in the recommended time frame were assessed. A total of 598 radiology reports were identified with structured recommendations: 462 for additional or future radiologic studies and 196 for nonradiologic actions (119 specialty referrals, 47 invasive procedures, and 43 other actions). The overall rate of completed actions (loop closure) within the recommended time frame was 87.4%, with 31 open loop cases rated by quality expert reviewers to pose substantial clinical risks. Factors associated with successful loop closure included (1) absence of accompanying contingency language, (2) shorter recommended time frames, and (3) evidence of direct radiologist communication with the ordering primary care physicians. A clinically significant lack of loop closure was found in approximately 5% of cases. The findings of this study suggest that creating structured radiology reports featuring a dedicated recommendations field permits the development of taxonomy to classify such recommendations and determine whether they were carried out. The lack of loop closure suggests the need for more reliable systems. This quality improvement study examines the communication of findings between radiology and primary care and implementation of recommended follow-up actions.
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影响因子：
5
作者：
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通讯作者：
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影响因子：
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