Department of Radiology, Brigham and Women's Hospital, Harvard Medical School, Boston, Massachusetts.
Director of Diversity, Inclusion, and Equity and Quality and Patient Safety Officer, Department of Radiology, Brigham and Women's Hospital, Harvard Medical School, Boston, Massachusetts.
J Am Coll Radiol. 2023 Aug;20(8):781-788. doi: 10.1016/j.jacr.2023.05.004. Epub 2023 Jun 10.
Assess the effects of feedback reports and implementing a closed-loop communication system on rates of recommendations for additional imaging (RAIs) in thoracic radiology reports.
In this retrospective, institutional review board-approved study at an academic quaternary care hospital, we analyzed 176,498 thoracic radiology reports during a pre-intervention (baseline) period from April 1, 2018, to November 30, 2018; a feedback report only period from December 1, 2018, to September 30, 2019; and a closed-loop communication system plus feedback report (IT intervention) period from October 1, 2019, to December 31, 2020, promoting explicit documentation of rationale, time frame, and imaging modality for RAI, defined as complete RAI. A previously validated natural language processing tool was used to classify reports with an RAI. Primary outcome of rate of RAI was compared using a control chart. Multivariable logistic regression determined factors associated with likelihood of RAI. We also estimated the completeness of RAI in reports comparing IT intervention to baseline using χ statistic.
The natural language processing tool classified 3.2% (5,682 of 176,498) reports as having an RAI; 3.5% (1,783 of 51,323) during the pre-intervention period, 3.8% (2,147 of 56,722) during the feedback report only period (odds ratio: 1.1, P = .03), and 2.6% (1,752 of 68,453) during the IT intervention period (odds ratio: 0.60, P < .001). In subanalysis, the proportion of incomplete RAI decreased from 84.0% (79 of 94) during the pre-intervention period to 48.5% (47 of 97) during the IT intervention period (P < .001).
Feedback reports alone increased RAI rates, and an IT intervention promoting documentation of complete RAI in addition to feedback reports led to significant reductions in RAI rate, incomplete RAI, and improved overall completeness of the radiology recommendations.
评估反馈报告和实施闭环通信系统对胸部放射学报告中额外成像建议（RAI）率的影响。
在这项回顾性、机构审查委员会批准的研究中，我们在学术四级保健医院分析了 176498 份胸部放射学报告，时间范围为 2018 年 4 月 1 日至 11 月 30 日（干预前[基线]期）；仅反馈报告期（2018 年 12 月 1 日至 2019 年 9 月 30 日）；以及闭环通信系统加反馈报告（IT 干预）期（2019 年 10 月 1 日至 2020 年 12 月 31 日），该系统提倡明确记录 RAI 的理由、时间框架和成像方式，将其定义为完整 RAI。使用经过验证的自然语言处理工具对有 RAI 的报告进行分类。使用控制图比较 RAI 率的主要结果。多变量逻辑回归确定与 RAI 可能性相关的因素。我们还使用 χ 统计比较 IT 干预与基线时的报告，估计 RAI 的完整性。
自然语言处理工具将 3.2%（176498 份报告中的 5682 份）分类为有 RAI；干预前为 3.5%（51323 份报告中的 1783 份），仅反馈报告期为 3.8%（2147 份报告中的 2147 份）（比值比：1.1，P =.03），而 IT 干预期间为 2.6%（68453 份报告中的 1752 份）（比值比：0.60，P <.001）。在亚分析中，干预前报告中不完整 RAI 的比例从 84.0%（94 份中的 79 份）下降至 IT 干预期间的 48.5%（97 份中的 47 份）（P <.001）。
仅反馈报告就增加了 RAI 率，而除反馈报告外，还促进记录完整 RAI 的 IT 干预导致 RAI 率、不完整 RAI 以及放射学建议整体完整性的显著降低。
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