Volume or Value? The Radiologist Role in Managing Radiological Exams

Abstract

Introduction: The purpose of this study was to understand the reasons and quantify the number of ultrasounds and computed tomographies that are potentially wasted in the hospital emergency in our institution, and the importance that the radiologist can have in the management and screening of these exams.
Material and Methods: It was defined that urgent tests that were pending for more than seven days would be the object of analysis as to why they were not performed, consulting the electronic medical records. Six causes were used to cancel the requests: ‘Changing the patient’s status’, ‘Patient’s withdrawal, refusal or abandonment’, ‘Patient’s death’; ‘No criteria or contraindicated’, ‘Lack of human resources’ and ‘Mistaken request’.
Results: In the year 2015 we obtained 1211 canceled exams, since they were pending more than a week ago. The first four causes totaled 602 exams (sum of 283, 94, 41 and 184). The last two, 609 (sum of 29 and 580).
Discussion: It was verified that the 602 exams corresponding to the sum of the first four causes reflected a potential waste in clinical tests since they were not determinant in the approach of the Emergency episode nor on the final destiny of the patient. Under the tip of the iceberg may exist further examinations and patients who have not escaped inadequate or unjustified examinations.
Conclusion: The radiologist can better manage the required radiological examinations, effectively screening within a multidisciplinary team environment, promoting the development and supporting the respect of guidelines, and potentially reducing requests through opinions or second opinions.