Communications Between Referring Physicians and the Radiologist
Brian Shiozawa, M.D.
Emergency Medicine Physician
A significant area of medico-legal liability is the timely and accurate receipt of radiology interpretations. There are a number of recent UMIA cases in which incomplete or delayed communication between the radiologist and the referring emergency medicine physician has occurred. This led to serious untoward consequences for patients including missed intracranial bleeds and delay in diagnosis of cancers. These results are catastrophic. The cases involve either delay in the receipt of the interpretation and/or incomplete preliminary information, which is later updated in a final report. In one case, a final updated report was never seen by the treating physician.
The American College of Radiology (ACR) cites the importance of communication between the radiologist and the referring physician.
“An effective method of communication should: (a) be tailored to satisfy the need of timeliness, (b) support the role of a diagnostic imager as a physician consultant by encouraging physician to physician communication, and (c) minimize the risk of communication errors.”
The ACR also notes the need for emergent/urgent readings. This generates non-routine communication. Such “Preliminary Reports” are often required in the ED, ICU or by surgery. The ACR policy notes that telephone or in-person communication is “appropriate and confirms the receipt of the findings.”
We clearly need to effectively address this persistent serious area of communication liability. A UMIA survey of “best practices” among our emergency department and radiology physicians reveals the following techniques to be effective in bridging/mitigating this potential area of serious legal liability. These practices will also improve/preserve the working relationships between the referring emergency department physician, intensivist, surgeon, etc. and the radiologist. Nothing is as divisive as a malpractice claim that imputes blame among treating physicians.
In the urgent and emergent situation, an appropriate communication would be a timely verbal report from Radiology that is accompanied by real time written documentation. Some hospitals use a system of immediate online “preliminary” interpretation which is then added to the medical record. An “official” report follows. Other hospitals with Power Scribe or similar voice recognition systems actually communicate a real time final report accessible by the treating physician. In both systems we have had little or no claims liability due to poor communication between the treating physician and radiology.
If you, as a referring physician, are in a hospital in which there are only verbal preliminary reports that are later transcribed into hard copy, we recommend the following:
- Request an upgrade to one of the aforementioned systems of real time written documentation to accompany the verbal reports.
- Request that written documentation (e.g. handwritten or online) from the radiologist be sent to the treating physician in real time.
The ED/treating physician should document the time, date and content of each preliminary verbal communication in the medical record. We further recommend that the ED physician then “read back” the information received to the communicating radiologist. The radiologist can then acknowledge and document his/her side of the communications.
If there are later discrepancies noted in over reads, the radiologist and hospital need to develop a fail-safe method of communication with the treating physician and/or representative. This should be written or verbally communicated as soon as possible with both parties acknowledgements noted in the medical records. Patient care must then be adjusted as necessary and such communication with the patient undertaken.
We hope that these recommendations will help you avoid the potentially dangerous issues of poor communication among Radiology and the referring physician.
