period, the percentage of noncritical radiology recommendations that were not acted on or acknowledged in the medical records, potential causes for recommendations not being acted on,
and the potential risk of harm to patients.
Of 6851 reports reviewed, 13% contained at least one noncritical recommendation. The two most common recommendations were additional imaging (63%) and clinical correlation
(23%). The majority of radiology recommendations were followed (67%), but 33% of cases contained no evidence that recommendations were followed.
Of those that were not followed, 39% had no documentation in
the medical records of the recommendation being acknowledged. Of those, 32% had important findings, half of which could
have benefitted from a verbal communication. Radiologists’ recommendations contained in written reports of noncritical findings may not be consistently followed or acknowledged in medical
records. The results of our study triggered an investment in systems improvement at the studied institution.
Reducing Delay in Diagnosis:
The purpose of this study was to determine whether a multistage tracking
system could improve communication
between health care providers, reducing
the risk of delay in diagnosis related to inconsistent communication and tracking
of radiology follow-up recommendations.
Recommendations for follow-up imaging associated with abnormal radiology test results are present in 2–5% of all radiology reports.
AJR in Brief continued from p. 19
A three-stage system known as the “Backstop” system was
developed to track recommendations for follow-up radiologic imaging studies and image-guided interventional procedures. All
imaging modalities were included, with the exception of mammography. Recommendations were tracked for patients from the
emergency department and inpatient and outpatient settings.
Unconditional recommendations for imaging follow-up were entered into a database and tracked through the Backstop system
for 13 months. Tracking interventions were performed for patients for whom completion of recommended follow-up imaging
could not be identified 1 month after the recommendation due
date. Postintervention compliance with the follow-up recommendation required examination completion or clinical closure (i.e.,
biopsy, limited life expectancy, or subspecialist referral).
Baseline radiology information system checks performed 1
month after the recommendation due date revealed timely completion of 43.1% of recommended imaging studies at our institution before intervention. Three separate tracking interventions
were studied, showing effectiveness between 29.0% and 57.8%.
The multistage tracking system increased the examination completion rate to 70.5% (a 52% increase) and reduced the rate of unknown follow-up compliance and the associated risk of delay in
diagnosis to 13.9% (a 74% decrease).
Performing sequential radiology recommendation tracking
interventions can substantially reduce the rate of unknown follow-up compliance and add value to the health system.n
Performing sequential radiology
recommendation tracking interventions can
substantially reduce the rate of unknown
follow-up compliance and add value to the
health system.—Ben Wandtke
Little is known about the risk that an ordering physician may overlook a noncritical radiology
recommendation that was communicated in a written report but that was not accompanied by a
verbal communication.—Nadja Kadom