In-Person Communication Between Radiologists and Acute Care Surgeons Leads to Significant Alterations in Surgical Decision Making |
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| Institution: | 1. Department of Radiology, University of Michigan Health System, Ann Arbor, Michigan;2. Department of Surgery, University of Michigan Health System, Ann Arbor, Michigan;3. Michigan Radiology Quality Collaborative, Ann Arbor, Michigan;1. University of California San Francisco, San Francisco, California;2. Warren Alpert Medical School of Brown University, Providence, Rhode Island;3. University of Chicago Medical Center, Chicago, Illinois;4. University of Wisconsin Hospital and Clinics, Madison, Wisconsin;5. Center for Diagnostic Imaging, St Louis, Missouri;6. University of South Alabama, Mobile, Alabama;7. Mayo Clinic, Rochester, Minnesota;8. Massachusetts General Hospital and Harvard Medical School, Boston, Massachusetts;1. Department of Radiology, MedStar Georgetown University Hospital, Washington, District of Columbia;2. National Center for Human Factors in Healthcare, MedStar Health, Washington, District of Columbia;3. Georgetown University School of Medicine, Washington, District of Columbia;4. Imaging Informatics, MedStar Medical Group Radiology, Washington, District of Columbia;1. Department of Radiology, University of Iowa Roy J. and Lucille A. Carver College of Medicine, Iowa City, Iowa;2. Section of Neuroradiology, Brigham and Women’s Hospital, Boston, Massachusetts;3. Northwestern University, Evanston, Illinois;1. Albert Einstein College of Medicine, Bronx, New York;2. Department of Radiology, Montefiore Medical Center, Bronx, New York |
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| Abstract: | PurposeThe aim of this study was to determine if direct in-person communication between an acute care surgical team and radiologists alters surgical decision making.MethodsInformed 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.ResultsOne 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).ConclusionsTargeted 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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| Keywords: | Quality improvement multidisciplinary collaboration decision making diagnostic error |
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