We have initiated a consultation project for clinicians who have questions about their patient’s imaging studies in diagnostic radiology. This is a prospective investigation centered around communication between diagnostic radiologists and clinicians who order radiology tests.
Consultation is available at York Street Campus (YSC) and Saint Raphael’s Campus (SRC) between 8:30 a.m. and 4:45 p.m. for all radiology modalities (CT, MRI, ultrasound, etc.), except pediatric and interventional radiology
- Ensure the appropriate imaging study is ordered
- Improve communication and quality of care
- Reduce repeat exams and number of exams
- Decrease delays, potential errors, and adverse events
- Promote provider and patient satisfaction
Kevin Johnson, MD
Consultations will be provided by Dr. Kevin Johnson, Associate Professor of Radiology and Biomedical Imaging:
Mobile Heartbeat: 203.843.6097 (or search: “Diagnostic Radiology Consult Project”)
Curriculum Vitae: Dr. Kevin Johnson 2017
Personal Cell Phone: 203.430.9798
This is a prospective investigation centered around communication between diagnostic radiologists and clinicians who order radiology tests. It has been designated as a Quality Improvement Project by the IRB.
The overarching thesis is that closer communication between radiologists and the clinicians will improve patient care. The object is not to control expenses or reduce utilization of radiology tests. Rather, the focus is on how the radiologist understands/misunderstands the clinical questions, and on how the clinician understands/misunderstands the radiology results. Specifically we wish to find new ways to improve this communication. We hope to find at least one new, practical innovation to this end.
Over the past 15 years or so, and in particular after the introduction of PACs systems, radiologists and clinicians have directly interacted less and less. My conviction is that patient care has suffered as a result. For a cogent discussion from the perspective of a prominent hospitalist see Robert Wachter, The Digital Doctor, McGraw Hill, 2015, Chapter 6: “Radiology Rounds”. An article adapted from his book can be found here.
Better communication can have substantial impact. In one study in which radiologists and surgeons reviewed inpatient surgical patients cases periodically, “in-person meetings led to changes in surgeons’ diagnostic impressions in 43% (43 of 100) patients” [Dickerson et. al, J Am Coll Radiol 2016;13:943-949].
Each specialty has its own domain of knowledge and inevitably a limited grasp of that of other specialties. A study done at Yale by Seth Powsner et al. [Arch Pathol Lab Med 2000; 124:1040-1046], looked at surgeons’ comprehension of pathology reports and concluded that “Surgeons misunderstood pathologists reports 30% of the time.”
In another study by Andrew Rosencrantz [American Journal of Roentgenology 2017; 208:140-143], when radiologists used the term “cyst” to describe an uncomplicated liver cyst, 22% of clinicians felt that a follow-up study would be indicated. When the radiologist used the term “benign cyst” instead, this fell to 2%. Radiologists know that liver cysts are essentially always benign, but apparently non-radiologists do not. This is not surprising. Cysts in other organs can have much different implications. For example, a pancreatic cyst has a nontrivial risk of being pre-malignant and does need to be followed. Non-radiologists should not be expected to keep track of all these distinctions. Yet, radiology reports often do not spell these out. Conversely, radiologists are equally unaware of the implications of a host of clinical history details. However, orders for radiology studies often do not spell these out.
At the beginning of this project, we want to keep an open perspective as to what kinds of help clinicians might want or need. Because in recent times direct consultation with radiologists has become infrequent and unfamiliar, especially to younger trainees and staff, its value will not be readily apparent to them. So as a way to begin, we offer our help to that person who takes the initiative to call us, without prejudice as to the calls value our research goals. As a relationship is forged, those issues will naturally come into focus during discussions. Therefore, any medical question involving diagnostic radiology is welcome, covering any topic (with the exception of interventional and pediatric topics, for the time being).
While we want to help in any way we can, in general, we would not be the best contacts for questions regarding scheduling, late reports, billing and other administrative/logistical topics. Having said that, if the patient’s welfare is in the balance, call us.
When you bring a question to us, if it is outside our particular expertise, we will seek out an opinion from a subspecialist radiologist on your behalf and bring it back to you. Although Dr. Johnson has a broad experience in clinical radiology [link to CV], nonetheless many questions will require him to seek such help. Thus a certain amount of delay may be inherent to the consultation and we ask for your patience on that front.
Call “Diagnostic Radiology Consultation Project” or Dr. Kevin M. Johnson on Mobile Heartbeat at 203.843.6097 between 8:30 a.m. and 4:45 p.m. Monday through Friday, or via text. If you are unable to reach him with those methods, please call or text his personal cell phone (but DO NOT text patient identifiers to the personal phone).
Please have the following information ready:
- Patient’s name and medical record number
- Your question
- Your contact phone number and email
- Dates, locations, and if possible, reports of any outside imaging.
By consulting us, you agree to participate in the research project by answering a few questions at the beginning and at the end of the consult. The radiologist will guide you through these and record the answers. We will record your contact information in order to continue to communicate with you about the patient as needed.
Currently, this project is covered by one attending radiologist, Dr. Kevin Johnson. He is available by Mobile Heartbeat (MH) from 8:30 a.m. to 4:45 p.m. Monday through Friday at 203.843.6097. The number is listed in the contacts on MH under “Diagnostic Radiology Consultation Project”. At times, calls may be fielded by a radiology resident, also during those hours.
For simple questions involving clarification of the appropriate study to order, terminology, contrast agent use and the like, the verbal communication between the radiologist and the clinician will suffice, and the clinician is free to record the interaction is his or her note if that seems worthwhile. For more complex questions, the radiologist may enter a formal consult note into Epic.
No. The exception is formal review of outside radiology studies when needed, a mechanism for which is already in place.