Implementing a Structured Reporting Initiative Using a Collaborative Multistep Approach

doi:10.1067/j.cpradiol.2016.12.004

Current Problems in Diagnostic Radiology

Volume 46, Issue 4, July–August 2017, Pages 295-299

https://doi.org/10.1067/j.cpradiol.2016.12.004 Get rights and content

Abstract

Purpose

To describe the successful implementation of a structured reporting initiative in a large urban academic radiology department.

Methods

We describe our process, compromises, and top 10 lessons learned in overhauling traditional reporting practices and comprehensively implementing structured reporting at our institution. To achieve our goals, we took deliberate steps toward consensus building, undertook multistep template refinement, and achieved close collaboration with the technical staff, department coders, and hospital information technologists. Following institutional review board exemption, we audited radiologist compliance by evaluating 100 consecutive cases of 12 common examination types. Fisher exact test was applied to determine significance of association between trainee initial report drafting and template compliance.

Results

We produced and implemented structured reporting templates for 95% of all departmental computed tomography, magnetic resonance, and ultrasound examinations. Structured templates include specialized reports adhering to the American College of Radiologyʼs Reporting and Data Systems (ACRʼs RADS) recommendations (eg, Lung-RADS and Li-RADS). We attained 94% radiologist compliance within 2 years, without any financial incentives.

Conclusions

We provide a blueprint of how to successfully achieve structured reporting using a collaborative multistep approach.

Introduction

There is a growing body of evidence that structured reporting improves the quality and value of radiologistsʼ major work product, the radiology report.1, 2, 3, 4, 5, 6, 7, 8 Radiology leaders have called for optimization of reporting and the delivery of actionable information in radiology reports as a critical link in the imaging value chain.9, 10 However, the available published literature provides limited experiences in the overhaul of traditional reporting practices and comprehensive implementation of a structured reporting initiative. Prior reports have primarily described implementation at childrenʼs hospitals where efforts ended in success11, 12 or failure with lessons learned.¹³ The purpose of our report is to describe the successful multistep implementation of structured reporting in a large multisite radiology department with more than 80 radiologists who interpret studies for adults and children. We believe that our experience will be helpful for other large academic and multispecialty practices contemplating implementation of structured reporting and seeking a blueprint of how this can be done successfully.

Section snippets

Setting

The setting of this initiative was an academic urban tertiary care medical center, which performs approximately 650,000 radiology examinations per year. The department has 88 faculty, 36 residents, and 13 fellows. Both adult and pediatric patients are cared for in 4 hospitals and 11 outpatient imaging facilities. The department (besides for breast imaging, which had already implemented structured reporting using a different system) uses PowerScribe 360 (Nuance, Burlington, MA) for voice

Implementation

Over the 24-month period of template production and implementation (March 2014 to February 2016), CT, MR, and US examination volume for which templates were available increased incrementally with 95% of all volumes having standardized templates available by February 2016 (Fig). The multistep approach is outlined in Table 1; details of the abdominopelvic CT template creation are also included as an example of our process.

Compliance

There was an overall compliance rate of 94% to standardized structured

Discussion

In this report, we describe the successful implementation of a structured reporting initiative in a large multisite radiology department with a large number of faculty and trainee radiologists. Although there have been prior reports of successful implementation on a smaller scale at childrenʼs hospitals,11, 12 this report is the first for a large medical center that services both adults and children with a large number of staff radiologists. This experience can serve as a model for other

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These have been limited in scope regarding patient population (pediatric patients) or study type (cross-sectional imaging). The Goldberg-Stein et al study described excluding radiographs from their departmental structured template initiative because “the need for different types of reports for different patient contexts” posed difficulties in achieving consensus between stakeholder radiologists and clinicians [18]. Indeed, this highlights the perceived inflexibility of standardized structured templates for cross-divisional imaging studies, which, when compounded with radiologists’ concerns over loss of autonomy, fear of commoditization, potential increased errors with inappropriate usage, and workflow disruption, creates challenges toward practice-wise standardized structured template adoption and adherence.
We describe our experience in implementing enterprise-wide standardized structured reporting for chest radiographs (CXRs) via change management strategies and assess the economic impact of structured template adoption.
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CXR structured template adoption increased from 46% to 92% in phase 1 and to 96.2% in phase 2, resulting in an estimated 8.5 hours per month of radiologist time saved. CTB rates for both radiographs and all radiology reports showed a linearly increasing trend postintervention with radiography CTB rate showing greater absolute values with an average difference of 20% throughout the sampling period. The CTB rate for all modalities increased by 12%, and the rate for radiography increased by 8%.
Change management strategies prompted adoption of division-specific structured templates, and exposure via auto launching enforced widespread adoption of consensus templates. Standardized structured reporting resulted in both economic gains and projected radiologist time saved.
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Improved consistency in reporting can be achieved by quality initiatives.27 Examples of quality initiatives are developing working agreements with referring physicians to formulate essential information for imaging requests and radiology reports, implementing structured reporting to improve the quality of the reports, peer feedback among radiologists,28 and a feedback system for referring physicians. The results of the present study are the first step towards implementation of continuous or periodical feedback from referring physicians, and measuring its effect could be a valuable tool to increase the diagnostic quality of reports.
To investigate how neurologists perceive the value of the radiology report and to analyse the relation with the neurologists own expertise in radiology and the level of subspecialisation of radiologists.
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Most neurologists interpret all computed tomography (CT) and magnetic resonance imaging (MRI) studies themselves, and their self-confidence in making correct interpretations is high. Residents gave higher scores than neurologists for “Radiologist report answers the question” (p=0.039) and for “Radiologist reports give helpful advice” (p=0.001). Neurologists from university hospitals stated more frequently that the report answered their questions than neurologists from general hospitals (p=0.008). The general appreciation for radiology reports was higher for neurologists from university hospitals than from general hospitals (8.2 versus 7.2; p=0.003). Radiologists at university hospitals have a higher level of subspecialisation than those at general hospitals.
Subspecialisation of radiologists leads to higher quality of radiology reporting as perceived by neurologists. Because of their expertise in radiology, neurologists are valuable sources of feedback for radiologists. Paying attention to the clinical questions and giving advice tailored to the needs of the referring physicians are opportunities to improve radiology reporting.
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Further, it may be worthwhile to consider introducing structured reports in a phased manner to alleviate the concern among radiologists regarding the potential decrease in productivity when switching to a new style of reporting (57). Attaching financial incentives such as faculty bonuses to promote the use of structured reporting has been mentioned in the literature, although this may not always be necessary (57,59). Using data from a peer review process appropriately may be another method to help convince radiologists to use structured reporting.
Radiology reports are vital for patient care as referring physicians depend upon them for deciding appropriate patient management. Traditional narrative reports are associated with excessive variability in the language, length, and style, which can minimize report clarity and make it difficult for referring clinicians to identify key information needed for patient care. Structured reporting has been advocated as a potential solution for improving the quality of radiology reports. The Association of University Radiologists—Radiology Research Alliance Structured Reporting Task Force convened to explore the current and future role of structured reporting in radiology and summarized its finding in this article. We review the advantages and disadvantages of structured radiology reports and discuss the current prevailing sentiments among radiologists regarding structured reports. We also discuss the obstacles to the use of structured reports and highlight ways to overcome some of those challenges. We also discuss the future directions in radiology reporting in the era of personalized medicine.
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^☆: The study was performed after IRB exemption.

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Implementing a Structured Reporting Initiative Using a Collaborative Multistep Approach☆

Abstract

Purpose

Methods

Results

Conclusions

Introduction

Section snippets

Setting

Implementation

Compliance

Discussion

J Am Coll Radiol

J Am Coll Radiol

J Am Coll Radiol

J Am Coll Radiol

Structured reporting: Patient care enhancement or productivity nightmare?

Radiology

Improving communication of diagnostic radiology findings through structured reporting

Radiology

Creation and implementation of department-wide structured reports: An analysis of the impact on error rate in radiology reports

J Digit Imaging