In-Person Communication Between Radiologists and Acute Care Surgeons Leads to Significant Alterations in Surgical Decision Making

In-Person Communication Between Radiologists and Acute Care Surgeons Leads to Significant Alterations in Surgical Decision Making

Abstract Purpose The aim of this study was to determine if direct in-person communication between an acute care surgical team and radiologists alters surgical decision making. Methods Informed consent was waived for this institutional review board-exempt, HIPAA-compliant, prospective quality improve...

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Bibliographic Details
Published in:Journal of the American College of Radiology Vol. 13; no. 8; pp. 943 - 949
Main Authors: Dickerson, Elliot C., MD, Alam, Hasan B., MD, Brown, Richard K.J., MD, Stojanovska, Jadranka, MD, Quality Collaborative, Michigan Radiology, Davenport, Matthew S., MD
Format: Journal Article
Language:English
Published: United States Elsevier Inc 01-08-2016
Subjects:
Clinical Decision-Making
collaboration
Decision Making
diagnostic error
Interprofessional Relations
Michigan
multidisciplinary
Patient Care Planning - statistics & numerical data
Patient Care Team - statistics & numerical data
Quality improvement
Radiologists - statistics & numerical data
Radiology
Surgeons - statistics & numerical data
Quality improvement
multidisciplinary
diagnostic error
collaboration
decision making
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Summary:Abstract Purpose The aim of this study was to determine if direct in-person communication between an acute care surgical team and radiologists alters surgical decision making. Methods Informed consent was waived for this institutional review board-exempt, HIPAA-compliant, prospective quality improvement study. From January 29, 2015 to December 10, 2015, semiweekly rounds lasting approximately 60 min were held between the on-call acute care surgery team (attending surgeon, chief resident, and residents) and one of three expert abdominal radiologists. A comprehensive imaging review was performed of recent and comparison examinations for cases selected by the surgeons in which medical and/or surgical decision making was pending. All reviewed examinations had available finalized reports known to the surgical team. RADPEER interradiologist concordance scores were assigned to all reviewed examinations. The impression and plan of the attending surgeon were recorded before and after each in-person review. Results One hundred patients were reviewed with 11 attending surgeons. The in-person meetings led to changes in surgeons’ diagnostic impressions in 43% (43 of 100) and changes in medical and/or surgical planning in 43% (43 of 100; 20 acute changes, 23 nonacute changes, 19 changes in operative management) of cases. There were major discrepancies (RADPEER score ≥3) between the impression of the reviewing radiologist and the written report in 11% of cases (11 of 100). Conclusions Targeted in-person collaboration between radiologists and acute care surgeons is associated with substantial and frequent changes in patient management, even when the original written report contains all necessary data. The primary mechanism seems to be promotion of a shared mental model that facilitates the exchange of complex information.
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ISSN:1546-1440
1558-349X
DOI:10.1016/j.jacr.2016.02.005