Improving Care and Education Through a Radiology Resident-driven Clinical Consultation Service

Rationale and Objective

As health care moves toward bundled payment systems and merit-based incentive models, increasing awareness of the value of the radiologist is essential. A resident-driven clinical imaging rounds (CIR) program initiated at our institution allows radiologists to actively and directly participate in the team-based medical model. A retrospective review of survey data evaluated the qualitative and quantitative effects of CIR on clinical management, communication, and education of referring providers and radiology residents.

Materials and Methods

The initial 10 months of a resident-organized CIR were evaluated in a retrospective study. Twenty radiology residents and 150 internal medicine physicians and medical students participated in imaging rounds. An anonymous survey of participants was performed and results were analyzed.

Results

Eighty-five percent of radiology resident participants completed the survey ( N = 17). Approximately 30% of internal medicine participants completed the survey ( N = 45). There was an overwhelming positive review of imaging rounds, with a large majority of all groups agreeing that imaging rounds improve education, communication, and patient care.

Conclusions

Resident-driven imaging rounds provide a valuable opportunity to improve communication, education, and patient care. We have created a CIR with a sustainable workflow that allows direct and regularly scheduled imaging-medicine consultation valued by both radiologists and internal medicine physicians, improving the quality of patient care and providing education to our radiology residents in value-based care.

Background

Radiology consultation by referring physicians has traditionally been a part of standard clinical practice and reported as a preferred method of decision support for imaging . Before the widespread availability of picture archiving and communication system (PACS), traditional film rounds provided an opportunity for direct and iterative information exchange between the radiologist and the remainder of the care team, and served as a showcase for the expertise of the radiologist . Dedicated radiology consultation services have been implemented in the past . However, these have not become widespread likely as a result of the volume-based fee-for-service payment, which favors interpretations over consultative activities. As health care moves toward merit-based incentive models and alternative payment models, increased opportunities will arise for the radiologist to add value through improving quality and limiting costs. Awareness and documentation of contributions by radiologists are essential for radiologists to be recognized and compensated for the value they add .

The need for such a system has been emphasized by our professional organizations, which have developed campaigns to educate radiologists on the importance of value and quality of care in addition to quantity, as more and more focus is placed on the patient experience and referring physician satisfaction. Imaging 3.0, as defined by the American College of Radiology, is a “multiphase program consisting of services, technology tools and processes that enable radiologists to adapt how they manage their practices, patient care and their own futures.” Its purpose is to position radiologists as expert consultants to referring physicians and health systems, to support radiologists as diagnosticians and consultants, to empower patients and providers, and to align incentives, as payment incentives increasingly focus on value-based care . Based on the principles of Imaging 3.0, Action Case Studies have demonstrated the impact attending radiologists can make by providing accessible consultation services. “Case Study: Radiology’s Open Door” illustrates that traveling to the referring clinician work site to educate and listen to referring clinicians strengthens the visibility and credibility of radiologists as locally available consultants . “Case Study: The Value of Hard Work” demonstrated how quantifying radiologists’ contributions with a “Radiology Value-Added Matrix” resulted in a hospital-wide paradigm shift. Radiologists came to be considered “among the strongest physician leaders” within the hospital .

Improving Care and Education Through a Radiology Resident-driven Clinical Consultation Service

Rationale and Objective

Materials and Methods

Results

Conclusions

Background

Methods

Results

Discussion

Appendix 1. Anonymous Electronic Survey Distributed to Radiology Residents Who Participated in the CIR

Appendix 2. Anonymous Electronic Survey Distributed to CIR Participants Within the Internal Medicine Department

References

Further Reading

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