Help or put on hold: when do you keep your colleagues waiting?
Survey results show that the radiologist’s availability to clinical colleagues is an important part of the imaging service. So how do you balance that availability and your regular workflow? We want to hear your thoughts below.
In 2011, Lindsay et al. published the results of a survey aimed at assessing what factors affected satisfaction with radiology services amongst referring clinicians (1). The survey was conducted shortly after implementation of a PACS system across three hospitals, and focused mainly on the changes created by improved communication between radiology and other hospital departments. Overall, respondents had a positive opinion of the impact of PACS installation, with the majority feeling it decreased the reporting times and ameliorated the working pattern for medical staff. Furthermore, there were a number of indicators showing that direct access to the radiological images did not decrease the importance of the radiology reports. On the contrary, the higher the experience of the referring clinicians, the higher the perceived value of this part of the radiologists’ work.
Many factors have been analysed, but the only one with a significant association with increased satisfaction amongst clinicians was having an approachable radiology service to interact with. The referring physicians’ desire (or, rather, their clinical need) to be able to contact radiologists directly is quite important. It demonstrates that availability of the radiologist for discussion is one of the most valuable assets of the radiological department and indicates there is a need to make it possible. Clinico-radiological meetings and an organisation that allows time for clinico-radiological communication are quite important. Availability, however, is also something quite personal.
How do we answer phone calls from referring physicians while sitting at the workstation with a long list of examinations to report? How do you keep control of your own availability to your clinical colleagues? Let us know in the comments section below.
Prof. Lorenzo Derchi is Chair of the Radiology Department of the Hospital of the University of Genoa and the ESR Publications Committee.
1. Lindsay R, McKinstry S, Vallely S, Thornbury G (2011) What influences clinician’s satisfaction with radiology services? Insights Imaging 2;425-430
Although it has been reported that answering calls during interpretations can affect the quality of the report (at least for the residents http://www.auntminnie.com/index.aspx?sec=sup&sub=imc&pag=dis&ItemID=108767), I think it is very important to maintain a strong communication with the clinician, who can provide you essential details about the case and help you reduce your differential diagnosis. I believe it is also very important to build a relationship with the clinican, so he can trust the radiologist and rely on his opinion.
Maybe a solution for not interrupting the work every time a clinician calls, would be calling hours – specified times when the radiologist is able to take calls and answer questions (maybe 10 minutes at every hour).
Another idea would be that the radioloist calls the clinican after every report, but this is possible only if the exam list is not very long and the cases are more complex.
A Radiologists is a Medical Doctor who has to INTERACT with patients, clinicians, hospital managers, public, and even media. However, this part of the job, especially for some who chose Radiology to deal with images and not patients, is time consuming, tiring and difficult. It requires will to act and training, but it is essential. The solution is hard to be find but it has to be found. I totally agree with the post of Adriana and I think that finding a “call time” or something organized to discuss radiological reports is crucial for the discipline.
Yes, as radiologists we have to find a way to create a quiet working climate with almost no distraction, to prevent inattentional errors (1) and improve our reporting. Others have already published that multitasking is unsafe and inefficient. Not only for residents but, unfortunately, as expected, also for consultants.
On the other hand, we should offer an approachable radiology service to interact with the referring clinicians.
So the solution might be to abandon the rule tat every call has to be answered immediately by every radiologist and to create a non-interruption area together with an interaction area instead.
I highly recommend to have a look at the following EPOS poster:
(1) ECR 2014 / C-0899 “Cognitive Errors in Radiology:“Thinking fast and slow” written by G. Jager, J. J. Futterer, M. Rutten;’S-Hertogenbosch/Nijmegen, The Netherlands.
“As the second leading cause of medical error, diagnostic error is a major health care concern and worthy of much more attention than it has received. A blame free climate to discuss errors on a regular base is helpful to get insight in the cognitive root causes of error. The system can be improved by creating a quiet working climate with almost no distraction, to prevent inattentional errors.”
In Norway we have daily meetings (in our hospital the very first thing at 8am) with the clinicians where all important cases are discussed or demonstrated. The good thing s that most doctors ask questions just after the meeting and then go and do their work, which leaves radiologists time to report peacefully. The on- call radiologist gets calls quiet often, but that is the only day in the week, and on-call cases are different than the heavy compliacted cases we do on regular days. One could say our “calling” hours are these meetings. We als experience that towards the end of the day doctors tend to call or return to seek us out to ask questions about patients when they don’t want to wait for the 8am meeting.
I realised that not every country has such “demonstration” meetings, some consider it a waste of time that 30 doctors all sit and look at images of cases they are not responsible for, but we hold on to this tradition because it is a very good way to learn for clinicians and us.
I think if a radiologist never meets the clinicians and never talks to them, she/he will in certain cases miss out on important diagnosis.
I think if you have no regular meeting, then clling hours is a very good solution.
There are areas of “acute care” and areas of quiet reporting within our department. However, one of the issues you face is the many unncessary phone calls as the “acute number” is seen as the entrance portal to Radiology.
We have now instituted a specific secretary to take all calls and filter them. For those that just want x-ray reported, she creates a list to hand over to the duty radiologist to deal with on a regular basis. For non-urgent things (often “how do I arrange for …” or “where can I find Dr …”) she will sort the phone call herself. For urgent matters, she connects the physician directly to the duty radiologist.
This filtering has seen a significant improvement of workload management already, not to mention that the reporting has become more managable.
Lastly – we have an open door policy for physicians to discuss cases with the duty radiologist. What we were seeing though, was many “routine” calls that were not urgent, yet interrupted our work to make it impossible to get to significant reporting.
I think the essential problem here is that we tend to see interaction with our clinical colleagues (whether it be on the phone or in multidisciplinary team meetings) as an interruption of our ‘real work’ (reporting), while in fact: interacting with our clinical colleagues (and patients) should be our priority.
I know this is an idealistic point of view in a world where we get paid by the number of reports rather than high quality patient care, but only we can change this… We should work towards a system where we get credits for our participation in MDT’s and clinical meetings.
In the mean time, there are several strategies we use to reduce the issue of multitasking: 1. we have a dedicated mobile number per subspecialty, which is answered by a fellow or consultant (not the most junior member of staff) to ensure that clinicians always have access to radiological expertise; 2. we commonly and highly efficiently communicate with our clinical colleagues by email, for any question, second look or opinion; 3. we never skip our clinical-radiological meetings, so our clinical colleagues know we will be there to answer their questions and thus don’t feel the need to ‘disturb’ us when we’re reporting.
All comments underline the importance of being available when calls from our colleagues come in and the need for an organisation that allows a quiet environment for reporting to prevent unintended mistakes.
Three possible solutions have been suggested: an interaction area, where someone is available and answers the calls, and a defined ‘calling time’ at the beginning and/or end of each workday. Both solutions work and seem able to satisfy both the needs of referring physicians to get the information they want and the necessity of radiologists to make their reports in a peaceful environment.
A third solution, in which a secretary filters the non-urgent calls, seems even better: only calls with immediate clinical urgency reach the on-duty radiologist.
A decrease in face-to-face communication between radiologists and clinicians has been observed after the implementation of PACS systems (1). The most likely explanation is that with a hospital-wide PACS images and reports can be easily reviewed outside the radiology department. Clinicians need to discuss with the radiologist and call him/her only when they have doubts or need further information. This, in most cases, can be done during the regular clinical-radiological meetings, during ‘calling times’, or can be managed by a secretary without interrupting the radiologist’s workflow.
The situation may differ in emergency radiology. In this setting, where therapeutic decisions must be taken quickly, the calls and visits from clinical colleagues, and especially from surgeons, are more frequent. They cannot wait for ‘calling time’. In emergencies, reports are made immediately and can be read as soon as they are ready. However, it is not a matter of diagnosis only. Severity, relationships and extent of a given lesion (even a “simple” acute appendicitis, but with a somewhat unusual location) are better understood when explained by the radiologist in front of the monitor of the workstation. Our ability to use its many display tools is much more advanced than theirs.
This disrupts the smooth workflow we would like to have and needs greater attention on our side in order to avoid mistakes. Maybe it decreases productivity too. But our availability in these cases makes us full members of the care-giving team.
1) Reiner B, et al. Impact of filmless radiology on frequency of clinician consultations with radiologists. AJR 1999; 173:1169-1172
Thank you for these interesting and fruitful comments. In our institution, strategies to filter phone calls and enhance availability of the radiological department are: dedicated mobile numbers both for the technicians and radiologists who are in charge of a specific modality, e.g. the MRI physician. We provide for each major clinical specialty and subspecialty weekly or even daily clinical-radiological meetings. Also, a so called radiological information center has been established with a dedicated key telephone system and four secretaries and one radiologist to take external phone calls and to filter them as well as to schedule MRI, CT, US examinations and to plan interventions. For the latter, a dedicated so called intervention manager has additionally been instituted to time the interventions and to organize placement and laboratory parameters etc. The on-call radiologists, especially during the week-ends, get a lot of phone calls; here, also dedicated on-call mobile numbers have been established for the radiologist who is at the week-end in charge of a specific modality, e.g. CT and CT-guided interventions.