Making a practice more patient-centered means "seeing the process as if you were the patient and expecting the process to work for you as a patient," said course presenter Michael N. Brant-Zawadzki, M.D.

In an era of consumer-driven healthcare, outsourcing of imaging services and growing competition, radiologists are being urged to see their work through the patient’s eyes and put the patient first in every step of the process.

"It's about having a doctor looking at a patient—maybe not directly with hands on, but certainly looking at a patient," said Michael N. Brant-Zawadzki, M.D. "Not a study—a patient."

Dr. Brant-Zawadzki, medical director of radiology at Hoag Memorial Hospital in Newport Beach, Calif., was among the presenters at an RSNA 2007 refresher course, "Patient-centered Radiology: Use It or Lose It." The course was sponsored by the RSNA Public Information Committee.

Making a practice more patient-centered also means "seeing the process as if you were the patient and expecting the process to work for you as a patient," said Dr. Brant-Zawadzki. It also means becoming more clinical in radiology practice, he said. "By clinical, I mean having direct interaction with a patient, even around procedures that are not performed directly hands-on by the radiologist."

Course co-presenter Philip O. Alderson, M.D., agreed that radiologists must reach out and connect with patients, especially in light of rapid changes in healthcare economics.

"There’s a real threat that interpretation of radiologic images could become a commodity," said Dr. Alderson, chair of the Department of Radiology at Columbia University Medical Center in New York. "Radiology services need to take on a much more personal quality for patients."

Radiologists can differentiate their practices by providing great local and personal services, said course presenter Philip O. Alderson, M.D. At left is course presenter Marcy Brown, R.T.

"Radiologists need to differentiate their practices by providing great local and personal services," Dr. Alderson continued. "You can’t replace local and personal services with film readings performed many miles or half a continent away."

Dr. Brant-Zawadzki acknowledged that radiologists are not patient-centered by training or culture, in the sense that they are consultants to other physicians.

"We worry about the type of equipment we have, whether our image quality is good, whether our technologists are well-trained and whether they treat the patients well," he said. "We don’t, as radiologists, tend to spend much time thinking about our direct focus on the patient."

Even when the radiologist does not touch the patient directly, the process can be made more patient-centered from start to finish, said Dr. Brant-Zawadzki. This includes interacting with the patient in a courteous and professional manner, having the study done as promptly as possible and, when feasible, sending the patient out with a preliminary result, he said.

"It’s a very simple concept," said Marcy Brown, R.T., director of radiology operations at Hoag Memorial Hospital and a course presenter. "Patients deserve the care that you or I would want when we get sick. Making their experience more comfortable is our number one priority."

Brown said Hoag Memorial has implemented a "one call" concept. "When patients call in, they’re not transferred about," she said. "The goal is obviously to get the patient in the right location at the right time, with the right prep."

The hospital tracks every call for volume, quality and average speed to answer. In the waiting room, staff members endeavor to keep patients informed about delays. A so-called "fix it fund" is available to help address patient complaints and "secret shoppers" have been enlisted to report their experiences in seeking services.

Dr. Brant-Zawadzki and Brown said they believe reporting of test results is one of the most important areas in need of improvement. The radiology staff may know within five minutes after a test that a patient has cancer, but the patient may have to wait a week to hear the results from his or her doctor. "That must be changed," they said.

Dr. Brant-Zawadzki added, "Given the fact that we have equipment that provides the information very quickly and efficiently, if it’s an urgent finding, the patient as well as the referring doctor should be told."

Other options include letting the patient know the report will be in the referring physician’s hands within a few hours or that the patient can view the report online. "And if you have any questions, here is a way to contact us. Here's an e-mail address or here's a chat room where you can talk to the radiologist directly," Dr. Brant-Zawadzki suggested.

Dr. Alderson presented an example of a patient-centered program developed at Scottsdale Medical Imaging in Arizona, in which radiologists meet with patients and talk with them about their radiology studies. Patients and referring physicians have responded very well to this approach, he said.

Providing such a consultative service directly to patients, Dr. Alderson concluded, "will help radiologists develop a new type of relationship with their patients as well as their referring physicians. Such patient-centered approaches can only strengthen radiology's future."

Quality Symposium Emphasizes Leadership, Teamwork to Improve Patient Care

Paul A. Larson, M.D.

Improving patient care was also the focus of the first Quality Improvement Symposium held at RSNA 2007.

"We’ve started to recognize the critical issues and understand that the keys to fixing them are leadership and teamwork," said presenter Charles R. Denham M.D., chair of the Texas Medical Institute of Technology (TMIT) in Austin.

Presenters offered a litany of statistics backing the need for quality improvement. According to the World Health Organization, the U.S. ranks 37th in the world in quality of care, despite healthcare expenditures nearly doubling those of other countries in the developed world. The National Patient Safety Foundation found that more than four out of 10 American consumers report being affected by a medical error, while the Institute of Medicine has reported that 44,000 to 98,000 preventable deaths occur each year in the U.S., costing Americans $28 billion.

Improving patient care quality is not only ethically important, but also driven by publicity and regulation, said presenters. Radiologists should use this challenge as a chance to make changes that may save money and save lives, presenters said.

Presenter Paul A. Larson, M.D., a radiologist at Radiology Associates of the Fox Valley in Oshkosh, Wisc., said radiologists can contribute by tailoring exams—incorporating such factors as body size, age, comorbid conditions, vascular access and gender—and "experimenting with the status quo."

"In radiology, there is a collapsed cycle time of impact of performance on improvement," concluded Dr. Denham. "This presents a terrific opportunity for radiologists."

The Quality Improvement Symposium was a project of RSNA’s Continuous Quality Improvement Initiative (CQI2). To learn more about CQI2, go to RSNA.org/quality.

These articles were adapted from stories that appeared in the RSNA 2007 Daily Bulletin. The daily newspapers from the annual meeting are available online at RSNA.org/bulletin.