Ring Ring Ring! Characterising Telephone Interruptions During Radiology Reporting and How to Reduce These

https://doi.org/10.1067/j.cpradiol.2018.01.004Get rights and content

Background

Telephone calls remain one of the most frequent interruptions in radiology reporting rooms, despite modern electronic order communication systems. A call received by a radiology trainee during the hour before completing a report may increase the chance of a discrepancy by 12%.

Aim

To characterise telephone calls to radiology reporting rooms and identify ways to reduce these interruptions.

Methods and Materials

An observational study over five working days (10 programmed activity reporting sessions equivalent) was conducted across 2 large teaching hospital reporting rooms. Radiologists were requested to record all calls between 9a.m and 5p.m on a preprepared Excel proforma and indicate their initial rating of call appropriateness.

Results

A total of 288 calls recorded, 92% (266/288) interrupted reporting. Reasons for calls were 48% (139/288) ask for a request to be vetted, 17% (50/288) ask for a study to be reported, 17% (45/288) “other,” 7% (19/288) discuss choice of study, 6% (16/288) review a report, 3% (9/288) wrong number, 2% (7/288) returning a bleep, and 1% (3/288) provide further explanation in addition to the electronic request form.

Conclusion

Radiologists and referrers remain over reliant on telephone interruptions for their workflow. Attempts to educate referrers previously reduced calls to a computed tomography reporting room by 28%. Our recommendations include (1) defining protected activities, (2) adhering to fully electronic requesting and vetting processes, other than in time critical or exceptional circumstances, (3) electronic critical report alerts and review of report priority triaging to reduce calls for reports, (4) revising duty radiologist timetables to tackle nonreporting responsibilities, and (5) improving new doctor induction in the organization to improve radiology request practice.

Introduction

It is part of everyday practice for healthcare professionals to interrupt one another to communicate urgent information. Interruptions during radiology reporting cause inefficiency and potentially harm to patients.1 When an individual’s attention is diverted from their primary task, memory of the primary task begins to decay while processing the interrupting task.2, 3 After returning to complete the remainder of the primary task, the likelihood of making an error is increased.4

During reporting sessions in our department, radiologists often are required to perform additional responsibilities which are a distraction from the primary task of, sometimes time critical, diagnostic image interpretation. These include vetting requests, protocolling studies and dealing with radiographer queries, ad hoc in-person clinical discussions, consenting pregnant patients, intravenous cannulation, contrast administration, attending contrast reactions, ad hoc ultrasound scanning and verbal communication of critical findings. Noninterpretative responsibilities now consume an oversized portion of reporting radiologists’ time and attention.5

Many efforts continue to be made to increase patient safety in our NHS hospital working environments. The WHO checklist mandates allowing time to perform what are basic safety steps, but designing safety in radiology workflow scenarios where interruption can reduce accuracy have received less attention. Modern radiology order communication systems with linked electronic patient records mean that telephone interruptions to communicate requests and reports are necessary only in exceptional circumstances (eg, change in the clinical situation affecting scan protocolling or an increase in urgency since the information was initially submitted). Despite this, telephone calls are one of the most frequent interruptions to radiology reporting.5

Numerous studies report an overall major discrepancy rate between radiology trainees’ initial reports and consultants’ final reports of 1%-2%, which is relatively constant.5 Minor but nevertheless important discrepancies are commoner. A number of variables affect this, however, a call received by a radiology trainee during the hour before completing a report may increase the chance of a discrepancy by 12%.6 An audit abstract by Muir et al in Edinburgh, Scotland, 2013, reported that 52% of calls received during CT reporting sessions were considered inappropriate.7 To our knowledge, that abstract is the only previously published information on the nature of telephone interruptions during radiology reporting.

We aimed to characterise telephone calls to radiology reporting rooms and identify potential ways to reduce these.

Section snippets

Materials and Methods

An observational study over five working days (10 programmed activity reporting sessions equivalent) was conducted across two large teaching hospital reporting rooms in London, UK. Radiologists were requested to record all calls, including indication of their rating on appropriateness, between 9a.m and 5p.m on a proforma.

Results

Twenty-three forms were returned in total, by Radiology Specialty Training year 1s (ST1s) (8), ST2s (6), ST3s (2), ST4s (1), ≥ST5s (2), and Consultants (4).

Of 288 calls recorded, 92% (266/288) interrupted reporting.

Callers were Senior House Officers 45% (129/288), Registrars 18% (51/288), Foundation Year 1s 11% (32/288), other staff 22% (62/288), and Consultants 5% (14/288).

Reasons for calls were 48% (139/288) ask for a request to be vetted (usually urgent investigations work, the caller

Discussion

Due to time pressures on radiologists completing forms, our data under-represents the total number of calls.

Calls to ask for imaging requests to be vetted comprised the highest number of calls overall and of calls deemed inappropriate by the reporter. This was followed by “other” calls and to ask for studies to be reported. Calls to ask for vetting were underrepresented because, of the “other” calls 14 were listed as requests for vetting. Over half of all calls for vetting and for reports to be

References (10)

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    Vetting and protocolling scan requests has been shown to be the most common reason for telephone calls which interrupt radiology reporting.1,2

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1

FAO Dr Christopher Watura, Imaging Department, Charing Cross Hospital, Fulham Palace Rd, London W6 8RF.

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