Related content: Quality Assurance, Workflow, Gastrointestinal

Dickerson EC, Alam HB, Brown RK, Stojanovska J. In-Person Communication Between Radiologists and Acute Care Surgeons Leads to Significant Alterations in Surgical Decision Making. J Am Coll Radiol. 2016 Aug;13(8):943-9

Radiologists and surgeons should talk (with each other)

Targeted in-person multidisciplinary collaboration between radiologists and acute care surgeons substantially changes patient management. A shared mental model facilitates the exchange of complex information.

Modern electronic medical record systems deliver imaging and interpretation data instantaneously, however, these sterile electronic communication methods include the risk of different assessments. In order to determine, if direct in-person communication between an acute care surgical team and radiologists alters surgical decision making, the Michigan Radiology Quality Collaborative, University of Michigan Health System, Ann Arbor/MI, USA, initiated semiweekly multidisciplinary meetings of about 60 minute.

Main topics of these meetings were comprehensive abdominal imaging assessments including historical radiologic examinations and clinical data. Abdominal surgeons had the opportunity to view images, see the precise location or absence of findings and to ask clarifying questions. Diagnostic impressions and treatment plans before and after these meetings were compared.

100 patients were reviewed in 21 meetings with 11 attending surgeons and 3 radiologists. The in-person meetings led to changes in the medical and/or surgical management plans in 43% of cases (95% CI 33%-53%): 47% of these (20 of 43) were changes in acute management, 53% (23 of 43) were changes in nonacute management, and 44% (19 of 43) resulted in changes in operative management. In 11 (11 of 100) of cases, major discrepancies appeared (concordance score RADPEER ≥ 3) between the impression of the reviewing radiologist and the written report.

In oncologic care interdisciplinary “tumor boards” are frequently incorporated – specialists from different sections work together. The implementation of such a model on a routine schedule is more complicated in acute settings, but the results described here indicate that it can be managed within an adequate time schedule and may considerably improve patient management.

Conclusion

Communication that relies solely on the electronic medical record can result in failures of information exchange. This can be remedied by face-to-face multidisciplinary collaboration: Direct in-person review of abdominal imaging studies between acute care surgeons and radiologists is associated with frequent and substantial changes in attending surgeon impression and management.