Frequency and Clinical Utility of Alerts for Intra-Institutional Radiologist Discrepant Opinions

Pamela J DiPiro; Andro Licaros; Anna H Zhao; Daniel I Glazer; Michael J Healey; Patrick J Curley; Catherine S Giess; Ramin Khorasani

doi:10.1016/j.jacr.2022.12.021

Frequency and Clinical Utility of Alerts for Intra-Institutional Radiologist Discrepant Opinions

J Am Coll Radiol. 2023 Apr;20(4):431-437. doi: 10.1016/j.jacr.2022.12.021. Epub 2023 Feb 24.

Authors

Pamela J DiPiro¹, Andro Licaros², Anna H Zhao³, Daniel I Glazer⁴, Michael J Healey⁵, Patrick J Curley⁶, Catherine S Giess⁷, Ramin Khorasani⁸

Affiliations

¹ Radiology Quality and Safety Officer, Department of Radiology, Center for Evidence-Based Imaging, Brigham and Women's Hospital, Boston, Massachusetts; Department of Radiology, Brigham and Women's Hospital, Harvard Medical School, Boston, Massachusetts; and Department of Imaging, Dana-Farber Cancer Institute, Harvard Medical School, Boston, Massachusetts. Electronic address: pdipiro@bwh.harvard.edu.
² Department of Radiology, Center for Evidence-Based Imaging, Brigham and Women's Hospital, Boston, Massachusetts; and Oncologic Imaging Fellow, Department of Imaging, Dana-Farber Cancer Institute, Harvard Medical School, Boston, Massachusetts.
³ Department of Radiology, Center for Evidence-Based Imaging, Brigham and Women's Hospital, Boston, Massachusetts; and Radiology Resident, Department of Radiology, Brigham and Women's Hospital, Harvard Medical School, Boston, Massachusetts.
⁴ Department of Radiology, Center for Evidence-Based Imaging, Brigham and Women's Hospital, Boston, Massachusetts; Medical Director of CT and Director, Cross-Sectional Interventional Radiology (CSIR), Department of Radiology, Brigham and Women's Hospital, Harvard Medical School, Boston, Massachusetts; and Department of Imaging, Dana-Farber Cancer Institute, Harvard Medical School, Boston, Massachusetts.
⁵ Department of Radiology, Center for Evidence-Based Imaging, Brigham and Women's Hospital, Boston, Massachusetts; and Associate Chief Medical Officer, Department of Medicine, Brigham and Women's Hospital, Harvard Medical School, Boston, Massachusetts.
⁶ Executive Director, Quality, Safety, Equity & Experience, Enterprise Radiology, Department of Radiology, Center for Evidence-Based Imaging, Brigham and Women's Hospital, Boston, Massachusetts.
⁷ Department of Radiology, Center for Evidence-Based Imaging, Brigham and Women's Hospital, Boston, Massachusetts; Deputy Chair, Department of Radiology, Brigham and Women's Hospital, Harvard Medical School, Boston, Massachusetts; and Department of Imaging, Dana-Farber Cancer Institute, Harvard Medical School, Boston, Massachusetts.
⁸ Vice Chair, Radiology Quality and Safety, Mass General Brigham; Vice Chair, Department of Radiology; Distinguished Chair, Medical Informatics; Director, Center for Evidence Based Imaging; Department of Radiology, Center for Evidence-Based Imaging, Brigham and Women's Hospital, Boston, Massachusetts; Department of Radiology, Brigham and Women's Hospital, Harvard Medical School, Boston, Massachusetts; and Department of Imaging, Dana-Farber Cancer Institute, Harvard Medical School, Boston, Massachusetts.

PMID: 36841320
DOI: 10.1016/j.jacr.2022.12.021

Abstract

Objective: Determine the rate of documented notification, via an alert, for intra-institutional discrepant radiologist opinions and addended reports and resulting clinical management changes.

Methods: This institutional review board-exempt, retrospective study was performed at a large academic medical center. We defined an intra-institutional discrepant opinion as when a consultant radiologist provides a different interpretation from that formally rendered by a colleague at our institution. We implemented a discrepant opinion policy requiring closed-loop notification of the consulting radiologist's second opinion to the original radiologist, who must acknowledge this alert within 30 days. This study included all discrepant opinion alerts created December 1, 2019, to December 31, 2021, of which two radiologists and an internal medicine physician performed consensus review. Primary outcomes were degree of discrepancy and percent of discrepant opinions leading to change in clinical management. Secondary outcome was report addendum rate compared with an existing peer learning program using Fisher's exact test.

Results: Of 114 discrepant opinion alerts among 1,888,147 reports generated during the study period (0.006%), 58 alerts were categorized as major (50.9%), 41 as moderate (36.0%), and 15 as minor discrepancies (13.1%). Clinical management change occurred in 64 of 114 cases (56.1%). Report addendum rate for discrepant opinion alerts was 4-fold higher than for peer learning alerts at our institution (66 of 315 = 21% versus 432 of 8,273 =5.2%; P < .0001).

Discussion: Although discrepant intra-institutional radiologist second opinions were rare, they frequently led to changes in clinical management. Capturing these discrepancies by encouraging alert use may help optimize patient care and document what was communicated to the referring or consulting care team by consulting radiologists.

Keywords: Discrepant radiologist opinion; electronic peer learning tool; report addendum.

MeSH terms

Academic Medical Centers
Humans
Radiologists*
Referral and Consultation*
Retrospective Studies