For example, “Recommend follow-up head CT in 6 hours and neurosurgery consult.”, At a teaching institution, radiologists may need to decide between conveying results to the attending emergency medicine physicians or the residents. Radiologists must communicate results in a comprehensive and timely fashion to the appropriate person with acknowledgment of receipt and understanding of the information. A noncontrast computed tomography is ordered to rule out pulmonary embolism. Emergency Radiology Question: Which x-ray views are preferred for detecting pneumoperitoneum? Case scenario: A noncontrast head CT is ordered for the indication of chronic headache. Strategies for minimizing fatigue can include limiting workload to only truly emergent cases while on call, having overlapping or short call shifts, and providing more coverage to high-volume areas like ED CT. At its most effective, emergency radiology provides frictionless tools and support to allow emergency healthcare personnel to provide safe, effective, patient-centered care. In an ED setting, radiologists frequently receive incomplete or irrelevant clinical history, which can be a major source of error and inefficiency. This is one of the key components of the patient’s overall care in the department. The content of this publication is not intended as a substitute for medical advice. Some departments require periodic night shifts for staff and/or residents for ED calls. Participants in a peer-review process must understand and accept that the purpose of the process is to improve safety and is not punitive, to encourage uniform participation and meaningful intervention. In these situations, one should consult the standard protocol in his or her institution’s ED. Documentation should include the date and time of communication, the name of the person spoken to, and the context in which the results were discussed. In a busy emergency radiology practice, interruptions and distractions are frequent and can increase the possibility of errors. The source of this tension is rooted in some of the most common themes underlying medical staff conflict, namely, deficiency in communication, a lack of trust, and incorrect assumptions. Using the five tips outlined earlier, radiologists can achieve brief but impactful conversations in the ED. Case scenario: A noncontrast head CT is ordered with the indication syncope. However, incomplete clinical data and unavailability of old examinations may also contribute. It is equally important to perceive and respond to nonverbal cues from patients. In large departments, having many radiologists with a variety of subspecialty interests may be feasible, but this may not be possible in small departments. This can be achieved in a variety of ways, including direct integration of the electronic medical record (EMR) into the PACS, using support personnel to gather additional data, or launching an always-open EMR window on a separate computer or accessory monitor. Inappropriate interpretation, transcription mistakes, or deficient documentation of communication and recommendation can lead to errors in radiology reports, which in turn may result in legal action against radiologists. Correct patient identification is particularly critical in emergency radiology where images are frequently viewed (by a radiologist or other provider) immediately after they are acquired. In lawsuits, an ordering physician can claim ignorance of the proper actions following a radiology diagnosis, because the radiologist did not provide recommendations. In areas where an in-house radiologist is not available, a robust remote access network can be used to allow radiologists elsewhere to remotely view and report studies. The key to risk management is to acknowledge that mistakes happen and even the best processes and procedures will fail. It is imperative that physicians keep abreast of changes in their specialty and within their scope of practice. During holidays and weekends, some specialized services may need to be temporarily withdrawn or arrangements may need to be made with other healthcare providers. Emergency radiologists frequently encounter challenges and scenarios that require noninterpretive skills, many of which are outside the formal training that exists in most training programs. Remind the provider of physician-patient shared decision making, in which informing patients of options, and explaining the risks and benefits, is the cornerstone of patient autonomy and respect. False-positive or cognitive errors are more likely to be related to a lack of experience or knowledge, rather than external factors. For radiologists who fail to recognize these scenarios or are poorly equipped to handle the challenges, there can be a significant impact upon patient care and patient safety. Maintaining a friendly temperament despite the conflict helps radiologists foster reputations as valued and accessible colleagues. These phrases also represent a small form of flattery and can validate self-esteem, which may be important as hostile conversation often develops as a result of our colleagues feeling that their professional competence and reputation are under attack. In conversation, use the keywords, “Have you considered?” or “Have you thought about?” to demonstrate regard for their clinical judgment and expertise. Emergency radiology departments must have standard policies regarding what is expected and appropriate for preliminary interpretations so that radiologists and emergency providers have consistent expectations. If any recommendation was conveyed verbally, it is helpful to include it in the communication section as well. In many instances, reviewing images can save time, because a visual explanation of the disease process or abnormality may convey more than even a lengthy verbal discussion. Radiologists must be cognizant and take advantage of such opportunities when they arise. Authors of open access articles published in this journal retain the copyright of their articles and are free to reproduce and disseminate their work. McCort JJ, Trauma Radiology. Emergency Radiology Course Friday 19th February 2021 Unit 42, St Olav's Court 25 Lower Road, Canada Water, London SE16 2XB Choose to attend in person or online (live streamed) False-positive errors can also delay the correct diagnosis, because the patient’s symptoms are incorrectly attributed to an alternate diagnosis. Visit our Open access publishing page to learn more. Most emergency radiology departments have adopted a systematic approach to patient safety such that the entire organization is constantly engaged in efforts to prevent and identify errors before they cause harm. Despite the potential for conflict, up to 40% of referring providers note that they would like to discuss imaging protocols in advance, and up to 50% are interested in feedback regarding protocol selection. Such data suggest tremendous opportunities for radiologists and emphasizes the increasing importance of effective conversation skills when delivering study results to patients. However, this is particularly challenging in the ED because treatment plans are often in flux during emergent situations, and there are multiple teams involved in caring for any single patient. Duke Radiology Emergency Imaging focuses on the best applications of MR, CT and Ultrasound in emergent situations, with practical solutions in mind. Patients might indicate, through their body language, emotions that they do not feel comfortable expressing out loud. Interventional Radiology. Therefore, it is important that emergency radiology departments adopt forward-thinking risk management strategies to identify areas of weakness and reduce the sources of error. PDF | On Aug 15, 2018, Eric Reichman published Reichman's Emergency Medicine Procedures, 3rd edition | Find, read and cite all the research you need on ResearchGate Using a comparison examination to establish temporal stability can help make an indeterminate finding more likely benign, which can help prevent unnecessary workup. Nitrous oxide and oxygen (N 2 O/O 2) provides a safe, simple and fast-acting alternative to oral medications for minimal sedation.During the procedure, patients experience reduction in pain and anxiety due to the analgesic and anxiolytic properties of N 2 O. Medical School: Yale University School of Medicine Residency: Bowman Gray School of Medicine, Wake Forest University, Winston-Salem, NC Board Certification: American Board of Radiology Societies: AMA, RSNA, ARRS, ACR, American Society of Emergency Radiology Several intrinsic (related to radiologist) and extrinsic factors (not directly related to radiologist) may be responsible for producing errors: This can be due to inadequately trained staff, poor equipment, or suboptimal working conditions, such as when a technologist is overwhelmed and unsupported. Radiologists and patients often have isolated encounters, without any prior patient-physician relationship established. Consistent poor-quality magnetic resonance imaging exam on weekends. INTERVENTIONAL RADIOLOGY. Emphasize your commitment to the relationship by stating, “I am happy to do what you feel is best, and from my point of view, this has been an educational and productive conversation.” Medicine can be a contentious profession, and it is difficult not to take altercations personally. An adverse event does not imply. The types of scenarios requiring noninterpretive skills are quite varied, ranging from communication and risk management to serving as a chaperone or managing intravenous contrast extravasation, which can make managing them particularly difficult for many radiologists. Harris JH, Harris WH, The Radiology of Emergency Medicine. A small spinal needle is guided into the back of the patient using fluoroscopy (real time imaging). However, the ACEP guidelines actually state that head CT is not indicated in syncope unless there is focal neurologic deficit, significant head trauma, or some other factor guided by history or physical exam.”. The role of the RIS-PACS administrator is critical in anticipating and identifying such errors before they affect patient care. Radiologist reads a normal variant as a fracture. This process involves all those who are responsible for the delivery of healthcare, not just the clinician who is directly caring for the patient. The department should have mechanisms for dynamically responding to increased workload (e.g., major disaster or trauma), including how to appropriately allocate and assign resources and personnel where needed. The following list of strategies will help radiologists improve communication skills with patients and family members in the ED. Over the phone, words and intonation are increasingly important, because they are the radiologist’s only form of communication. I am going to return to my work station and review it again carefully with my colleagues to confirm. It is also important not to let emotions control the conversation. To begin, it is important to be aware of the time constraint, especially in the busy setting in the ED. Online case-based review of emergency radiology featuring over 8 hours of video recordings by Dr Andrew Dixon, A/Prof Frank Gaillard and guests. This is an opportunity for radiologists to directly make a difference by ensuring quality patient care while minimizing litigation risk. Emergency department technician incorrectly labeled the wrong side on a busy day. Would he or she want a head CT now, knowing that it will not be helpful and expose the patient to radiation? Topics include abdominal, pediatric, neuro, musculoskeletal, cardiovascular and interventional imaging. 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