Actionable reporting [QSI Ref: XR-508]
Descriptor
Actionable reports are required for safe patient management. This audit is aimed at a few key points pertinent to this.
Did the report answer the clinical question?
Was a tentative or differential diagnosis provided for the abnormality?
Was advice provided regarding the next step?
Was the advice provided for the next step appropriate?
Background
What do patients want from their radiology report?
- A report that takes into account their past history, previous imaging, current symptoms and signs and the results of other diagnostic tests.
- A report that accurately describes the imaging findings, a diagnosis or stratified list of differential diagnoses, with suggestions for further appropriate imaging, other investigations or patient management.
They want it to be provided in a timely manner for reassurance, confirmation of diagnosis or identification of unexpected findings and for that report to be communicated to the referrer and/or appropriate multidisciplinary team with the degree of urgency, including failsafe mechanisms, related to the significance of the radiological findings or the urgency of the clinical scenario.
The Cycle
The standard:
Every department should aim to deliver actionable reporting.
The report should answer the clinical question. When an abnormality is described a tentative or differential diagnosis should be provided and appropriate advice provided regarding the next step.
Target:
The report should answer the clinical question: target 100%.
When an abnormality is described a tentative or differential diagnosis should be provided: target 100%.
Not all reports will have advice on the next step. However, where advice is given, the advice should be appropriate: target 100%.
Assess local practice
Indicators:
The report answered the clinical question
A differential or tentative diagnosis was provided
Appropriate advice was provided for the next step
Data items to be collected:
Data collection: choose a site-specific cancer MDTM (for example, lung) or non- cancer MDTM and review all the radiology reports for a specific time period sent to the MDTM (alternatively choose consecutive reports for a particular modality – ultrasound [US], CT, MRI and so on)
Exclusion: exclude reports which are normal.
Analyse both the request card and associated report to answer the following questions:
Did the referrer request he appropriate investigation for the clinical question?
Did the report answer the clinical question?
Was a tentative or differential diagnosis provided for the abnormality?
Was advice provided regarding the next step?
Was advice provided for the next step appropriate?
Was any urgent action flagged and relayed back to the referrer?
Data analysis should include job role (consultant radiologist, specialty grade doctor, post-FRCR trainee radiologists, pre-FRCR trainee radiologist, non-radiologist doctor, radiographer, physiotherapist etc.), referral type (emergency or elective) and employment status (NHS, locum or teleradiologist).
Suggested number:
100
Suggestions for change if target not met
Feedback via departmental/interdepartmental meetings or MDTMs
Retraining and mentored support
Re-audit
Resources
Personnel: clerical time to pull the necessary lists (MDTM lists etc.) and radiologists’ time to analyse the reports.
Time: allow eight hours per year for scrutinising records and preparing formal annual reports.
References
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Boland GW, Enzmann DR, Duszak RJr. Actionable reporting. J Am Coll Radiol 2014; 11(9): 844–845
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The Royal College of Radiologists. Standards for the communication of radiological reports and fail- safe alert notification. London: The Royal College of Radiologists, 2016.
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The Royal College of Radiologists. Standards for Learning from Discrepancies meetings. London: The Royal College of Radiologists, 2014.
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The Royal College of Radiologists. Lifelong learning and building teams using peer feedback. London: The Royal College of Radiologists, 2017.
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The Royal College of Radiologists. Standards for the provision of teleradiology within the United Kingdom, second edition. The Royal College of Radiologists, 2016.
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www.acr.org/Advocacy/Informatics/Data-Science-Institute?utm_ source=052317%5FMemberUpdate&utm_medium=email&utm_campaign=ACRMemberNews&_ zs=g42TD1&_zl=lkBo3 (last accessed 31/1/2018).
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The Royal College of Radiologists. Who shares wins: efficient, collaborative radiology solutions. The Royal College of Radiologists, 2016.
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https://www.datadictionary.nhs.uk/attributes_overview.html#attribute_overview (last accessed 1/6/21)
Editor’s comments
When carrying out this audit locally you may wish to concentrate on examinations where the referrer has asked a question. Depending on the clinical question it may be appropriate to include normal reports - especially if a normal report does not answer the question, but requires a different investigation or management plan which the radiologist should be indicating in their report.
The context / relationship of the clinical referrer and reporting radiologist should also be taken into consideration as the advice given to a general practitioner may differ from that provided within a subspecialty team
Whether this audit can be applied to examinations undertaken / reported by radiographers will depend on local policy, as this may state that radiographers should provide a factual report with clearly detailed findings, but not a differential diagnosis / conclusion or management plan.
Submitted by
Dr Caroline Rubin
Co-authors
Dr Neelam Dugar