Embedded Reading Rooms Bolster Communication with Clinicians

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Embedded Reading Rooms Improve Communication with Clinicians

Newly acquired research shows that healthcare institutions equipped with embedded reading rooms witness higher rates of communication between radiologists and clinicians.

Due to the existence of PACS, it is less accessible and feasible for radiologists to interact face to face with their clinician colleagues. And because of this, some healthcare facilities have embedded radiology reading rooms in clinical areas in attempts of enhancing and advancing direct communication between radiologists and referring physicians.

Fourth-year medical student at the University of California at San Francisco, Allison Tillack, Ph.D, and her peers examined a tertiary care U.S. academic hospital to assess whether embedded radiology reading rooms are linked to increased rates of direct communication between radiologists and clinicians.

Tillack’s research was funded by a 2011 Fujifilm Medical Systems/RSNA Research Medical Student Grant and has since been published in the May 2013 edition of the Journal of the American College of Radiology.

Tillack uncovered a “highly significant positive correlation” between the location of the reading room and communication between clinicians and radiologists. Embedded reading rooms provide the best opportunity of maximizing that correlation. Data revealed more visits to embedded reading rooms by referring clinicians than to reading rooms located in a different area of the facility.

“This could be the first quantitative study that shows radiologists integrate better with the remainder of our clinical colleagues if we are in a reading room that is embedded in their clinical service,” said vice-chair of the radiology department at the University of Colorado at Denver and Dr. Tillack’s scientific advisor and co-author of the study. Dr. Borgstede chairs the RSNA Research & Education (R&E) Foundation Board of Trustees, James Borgstede, M.D.

“The type, quality and length of communication all seem to be more appropriate when radiologists are in close contact geographically with their clinical colleagues,” he commented.

The facility presented in the study offered two embedded reading rooms (breast and musculoskeletal) and two non-embedded reading rooms (body and neuroradiologic imaging) situated in the hospital’s basement.

Tillack collected data upon occurrence, form (telephone, in-person visits and via Veriphy, a Joint Commission-recommended system for communicating critical test results), duration, and general reasons of communications. Over a span of eight weeks, she observed communications and gathered 175 incidents, 100 of which came from embedded reading rooms.

Personal trips to the embedded breast and musculoskeletal reading rooms significantly outperformed those to the non-embedded body and neuroradiology reading rooms (46 percent as opposed to 7 percent), while non-embedded reading rooms had a higher rate of Veriphy use than embedded reading rooms (40 percent versus 7 percent).

“This was a highly significant difference, but we couldn’t say for sure that it was caused only by the location difference. It’s certainly one of the hypotheses, and I think a very likely one, but we had to factor in the nature of different reading room work as well as culture. We couldn’t say for sure that this wasn’t just a particularly pro-interactive group of orthopedic surgeons or musculoskeletal radiologists, for instance,” said Tillack.

Additionally, Tillack noted that the musculoskeletal reading room was placed directly across the hall from the orthopedic surgery dictation room while the Rheumatology Department was just down the hall, making in-person visits expedient. No doors were attached to the reading room and clinicians regularly seen stopped by to discuss specific cases.

“It was a very collegial, friendly atmosphere. Orthopedic surgeons we talked to were excited about the convenience and said it was great to be able to drop by and look at a case with the radiologist without having to go downstairs,” she said.

Yet phone calls were still the most prevalent form of communication regardless of the reading room locations. Moreover, there was no noteworthy difference in the number of calls to embedded reading rooms (47 percent) and non-embedded ones (53 percent).

Tillack recognized that implementation of the study does have its share of limitations and restrictions, particularly regarding multispecialty clinics and/or private practices. In multispecialty practices it becomes difficult to decide where the reading room would be embedded. In the example of abdominal radiologists, would find it difficult to decide whether they should embed with gastroenterologists, nephrologists or urologists.

Researchers admit the study was met with restrictions and said they wish to carry out further research in the area, they assert that embedding supplies value for those seeking to enhance communications and raise the profile of radiologists within their work environments.

“The important thing is that the concept is out there. We’re in a different era than a generation ago when clinicians came to radiologists to look at film studies that could only be viewed in one place at a time. Now that’s not true. It’s a new paradigm and if they aren’t going to come to us, we have to go to them,” said Borgstede.

While Tillack acknowledges and thanks the RSNA for providing her with the proper funding to make such a study feasible.

“The RSNA grant was the inspiration for the project and allowed me to make the research happen. Learning to develop a very targeted question, work it through, do the analysis and take it to publication is really a valuable and fantastic experience. Making those connections with my mentor and other people who helped in the research has also been so valuable,” she said.