Ring Ring Ring! Characterising Telephone Interruptions During Radiology Reporting and How to Reduce These
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
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2023, RadiographyCitation Excerpt :Four senior radiographers pioneered the initiative, and the team had expanded to ten radiographers. The aim of this initiative was to reduce interruptions (mainly in the form of telephone consultations) to the interpretation and reporting of imaging examinations by radiologists, thereby relieving them from distractions and non-interpretative responsibilities.4 The elevation of the professional status and upskilling of radiographers following the evolvement of the undergraduate curriculum culminating in a degree,5 accreditation by the Allied Health Professional Council (AHPC) of Singapore,6 and along with the already present vast clinical knowledge and experience in the protocoling and performance of CT scans, were catalysts for the development of this radiographer-led vetting and protocoling initiative.
Radiography as a sociotechnical system – Improving patient identification with a multi-level human factors approach
2022, Safety ScienceCitation Excerpt :Phone calls are recognised as a common source of interruption and unnecessary calls require the same initial attention as important calls. In an audit of 288 calls to reporting radiologists it was found calls asking for image request vetting were the most frequent and the majority (54%) were judged as inappropriate (Watura et al., 2019), a similar rate to the 52% reported by Muir and Patel (2013). The most comprehensive study of an intervention to reduce interruptions for radiologists implemented a telephone triage system in which administrative staff filtered incoming calls (Bell et al., 2018).
Direct Access and Skill Mix Can Reduce Telephone Interruptions and Imaging Wait Times: Improving Radiology Service Effectiveness, Safety and Sustainability
2022, Current Problems in Diagnostic RadiologyCitation Excerpt :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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FAO Dr Christopher Watura, Imaging Department, Charing Cross Hospital, Fulham Palace Rd, London W6 8RF.