Computed tomography technologist notes in PACS to radiologists: what are they telling us and how does it increase value?

Abstract

In the clinical workflow of radiology services, a critical connection exists between technologists and radiologists, yet there is often limited communication between this key link in the chain of patient imaging. Our aim was to quantify and detail the communication between CT technologists and radiologists in our tertiary oncology practice. Using the note function in our EMR, as standard operating procedure, CT technologists are instructed to place pertinent notes for the radiologist relevant to any portion of the patient encounter. Note categories pertain to quality and/or safety: patient limitations (e.g., patient unable to raise arm), protocol confirmation (e.g., rectal contrast given), critical finding communication, scan range considerations, IV issues, reduction in eGFR, oral contrast issues, allergy information, general feedback, equipment malfunction, and radiologist approval information. The percentage of notes within each category were recorded upon review of contiguous abdominal CT scans in July 2018 with the primary outcome measure of overall note volume compared to baseline in July 2016 after which time technologists were educated on the importance of notes and were requested to increase use of this tool. Notes were regularly reviewed to identify practice improvement opportunities. Compared to baseline 2years earlier (8860 CT scans, 812 technologist notes), there was a 32% increase in technologist note volume (10,948 CT scans, 1330 technologist notes), representing an increase of notes from 9.2% of exams to 12.1% of exams (p < .001) and there were 14 related practice improvements. After communicating the importance of CT technologist notes and requesting increased notation frequency, technologist note volume significantly increased and 14 specific case examples of related practice improvement demonstrate the electronic medical record note function to be a robust tool in the management of patient imaging.