Support Tests.

Rob Bell rmsbell200 at YAHOO.COM
Tue Jan 26 19:23:17 UTC 2016


Good suggestion - l really like it when there are positive practical suggestions. We need to be doing something to prevent errors. Ideas here may be picked up by decision makers, modified, and become fact. So please all constantly suggest solutions. I have the idea that we need to start to be very pro-active if we want to advance the overall cause of preventing error in a reasonable period of time.

Rob Bell, MD

Sent from my iPhone

> On Jan 26, 2016, at 11:48 AM, Andrew Olson <olso5714 at UMN.EDU> wrote:
> 
> I think there are clear technological solutions that would allow for interaction between clinical and perceptual teams that don't involve the proverbial trip to a different part of the hospital, thereby modernizing a historical activity that was both inefficient and important.   It would be relatively easy to have a "click to chat with the radiologist" box in an EMR.
> 
>> On Tue, Jan 26, 2016 at 11:53 AM, Follansbee, William <follansbeewp at upmc.edu> wrote:
>> I trained in those days as well, with similar experiences. Your question is an important one and the answer is simple. There are no films anymore. Everything is now digital and is available at the point of care. The workflow no longer involves a trip to the radiology department. Those days are gone forever. The challenge is how can those interactions be reproduced in today’s work flow? That is a difficult challenge. The only way that I could envision that happening would be for radiologists to leave their department and make rounds, going to different inpatient services and making radiology rounds with them on site. This, of course, would be a major time commitment for the radiologists and for that reason might not be possible. Short of that, however, it is difficult imagine how to recreate it.
>> 
>>  
>> 
>> We also should not get too caught up in nostalgia. These interactions were quite valuable but they were also a highly inefficient use of time. Clinical teams would trek together to the radiology department, stand for what seemed like forever at the file room while clerks sorted through mountains of films trying to find the ones that were needed, which not infrequently weren’t even in the department, before those valuable interactions with the radiologists could occur. That is why when digital imaging came along, point of care availability of the images was immediately adopted.
>> 
>>  
>> 
>> An important issue but also a difficult challenge.
>> 
>>  
>> 
>> William P. Follansbee, M.D., FACC, FACP, FASNC, FAHA
>> 
>> The Master Clinician Professor of Cardiovascular Medicine
>> 
>> Director, The UPMC Clinical Center for Medical Decision Making
>> 
>> Suite A429 UPMC Presbyterian
>> 
>> 200 Lothrop Street
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>> Pittsburgh, PA 15213
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>> Phone: 412-647-3437
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>> 
>>  
>> 
>>  
>> 
>>  
>> 
>> From: Bob Latino [mailto:blatino at RELIABILITY.COM] 
>> Sent: Tuesday, January 26, 2016 11:55 AM
>> 
>> 
>> To: IMPROVEDX at LIST.IMPROVEDIAGNOSIS.ORG
>> Subject: Re: [IMPROVEDX] Support Tests.
>>  
>> 
>> If this practice was so effective in the 70's and 80's, why did it fade away? 
>> 
>>  
>> 
>> Why aren't such proven best practices maintained and sustained?
>> 
>>  
>> 
>> Robert J. Latino, CEO
>> 
>> Reliability Center, Inc.
>> 
>> 1.800.457.0645
>> 
>> blatino at reliability.com
>> 
>> www.reliability.com
>> 
>>  
>> 
>> From: Albert Wu [mailto:awu at JHU.EDU] 
>> Sent: Tuesday, January 26, 2016 11:05 AM
>> To: IMPROVEDX at LIST.IMPROVEDIAGNOSIS.ORG
>> Subject: Re: [IMPROVEDX] Support Tests.
>> 
>>  
>> 
>> I recall doing precisely this while a med student and resident at New York Hospital, and Mt Sinai in NYC in the mid 80s
>> 
>>  
>> 
>> albert
>> 
>>  
>> 
>> From: Alan Morris <Alan.Morris at IMAIL.ORG>
>> Reply-To: "IMPROVEDX at LIST.IMPROVEDIAGNOSIS.ORG" <IMPROVEDX at LIST.IMPROVEDIAGNOSIS.ORG>, Alan Morris <Alan.Morris at IMAIL.ORG>
>> Date: Tuesday, January 26, 2016 at 10:19 AM
>> To: "IMPROVEDX at LIST.IMPROVEDIAGNOSIS.ORG" <IMPROVEDX at LIST.IMPROVEDIAGNOSIS.ORG>
>> Subject: Re: [IMPROVEDX] Support Tests.
>> 
>>  
>> 
>> You may be interested to know that in the 1979s and 1980s we made daily rounds with the radiologist and interpreted the films together.  This was unequivocally produced remarkable returns and was a good investment of time in a high-tech intensive care unit.  Better communication is always desirable.  I am reminded of a quote from George Bernard Shaw:
>> 
>>  
>> 
>> “The single biggest problem in communication is the illusion that it has taken place."
>> 
>>  
>> 
>> Alan H. Morris, M.D.
>> 
>> Professor of Medicine
>> 
>> Adjunct Prof. of Medical Informatics
>> 
>> University of Utah
>> 
>>  
>> 
>> Medical Director, Urban Central Region Pulmonary Function Laboratories
>> 
>> Pulmonary/Critical Care Division
>> 
>> Sorenson Heart & Lung Center - 6th Floor
>> 
>> Intermountain Medical Center
>> 
>> 5121 South Cottonwood Street
>> 
>> Murray, Utah  84157-7000, USA
>> 
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>> Office Phone: 801-507-4603
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>> Mobile Phone: 801-718-1283
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>>  
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>>  
>> 
>> From: Leonard Berlin <lberlin at LIVE.COM>
>> Reply-To: Society to Improve Diagnosis in Medicine <IMPROVEDX at LIST.IMPROVEDIAGNOSIS.ORG>, Leonard Berlin <lberlin at LIVE.COM>
>> Date: Tuesday, January 26, 2016 at 05:56
>> To: "IMPROVEDX at LIST.IMPROVEDIAGNOSIS.ORG" <IMPROVEDX at LIST.IMPROVEDIAGNOSIS.ORG>
>> Subject: Re: [IMPROVEDX] Support Tests.
>> 
>>  
>> 
>> Without any doubt whatsoever, the radiology literature is replete  in confirming that the more clinical information  that is provided to radiologists.  the more accurate will be their reports.
>>  
>> Will clinical info on occasion bias the radiologist?  Yes, but very rarely.  Any potential "harm" of providing  the radiologist with clinical info is far, far,  outweighed by the benefit. 
>>  
>> Lenny Berlin, MD
>> Professor of Radiology,
>> Rush University and
>> Uiv. Ill, Chicago
>> 
>>  
>> 
>> > Date: Tue, 26 Jan 2016 04:30:40 +0000
>> > From: Joe.Grubenhoff at CHILDRENSCOLORADO.ORG
>> > Subject: Re: [IMPROVEDX] Support Tests.
>> > To: IMPROVEDX at LIST.IMPROVEDIAGNOSIS.ORG
>> > 
>> > Is there not data that indicated that giving more, not less, information to a radiologist in a requisition improves the accuracy and clinical utility of the interpretation? As an PEM physician I teach the residents that our radiology colleagues are consultants just like a cardiologist. Call them, ask what the most reliable study is for the clinical question. Saves time and money by avoiding unnecessary or inappropriate exams that don't resolve or often muddy the clinical picture.
>> > 
>> > Sent from Skynet
>> > 
>> > > On Jan 25, 2016, at 21:12, Elias Peter <pheski69 at GMAIL.COM> wrote:
>> > > 
>> > > I addressed my concerns to the radiologists and pathologists, not the hospital. They agreed that changes were needed, did not always agree on what changes were needed, and most were willing to try things to see what did and didn’t help.
>> > > 
>> > > The administrative structure was not impressed with the clinical request that we expend some of the institutions resources (time, IT work, communication system to discuss what we were doing) and the requests eventually died out. 
>> > > 
>> > > I understand the concern that clinical information might bias a radiologist’s reading. The same thing could be said about the patient history biasing my exam, test ordering, assessment or plan. The purpose of information is to point us in some direction. The solution to this is NOT to hide clinical information from the radiologist/pathologist (or the patient) but to make as much information available to as many people on the team as possible.
>> > > 
>> > > Peter Elias
>> > > 
>> > > 
>> > >> On 2016.01.25, at 9:08 PM, Stefanie Lee <stefanieylee at GMAIL.COM> wrote:
>> > >> 
>> > >> Part of the issue is framing (addressed in the recent IOM report) -
>> > >> the view of the diagnostic specialties as provider of test results,
>> > >> which are then used by the primary physician to diagnose the patient -
>> > >> versus the pathologist or radiologist as being integrated into the
>> > >> ongoing discussion and diagnostic process.
>> > >> 
>> > >> Communication is essential to safe patient care. As more than one
>> > >> scenario can have the same imaging appearance, it is the clinical
>> > >> information that allows the radiologist to form an educated opinion as
>> > >> to what the significance of the finding is (and avoid the dreaded
>> > >> 'cannot exclude'!)
>> > >> 
>> > >> Rim-enhancing collection with gas bubbles in the surgical bed - an
>> > >> abscess that needs to be drained, right? Not if Surgicel had been used
>> > >> during the operation (a hemostatic agent that has a very similar
>> > >> imaging appearance).
>> > >> 
>> > >> Given a CT or MRI which may have numerous abnormal findings in its
>> > >> hundreds/thousands of images, the diagnostic process of putting all
>> > >> the findings together to form an interpretation / hypothesis about
>> > >> what is going on is not really all that different from other fields in
>> > >> medicine.
>> > >> 
>> > >> Sometimes referring physicians are concerned about 'biasing' the
>> > >> radiologist with clinical information, but providing less information
>> > >> is unlikely to help improve accuracy - better communication will. If
>> > >> anything in the report doesn't fit - pick up the phone or send an
>> > >> email/fax for a second look!
>> > >> 
>> > >> As another example, consolidation on a chest radiograph is a
>> > >> nonspecific finding that very frequently represents pneumonia and is
>> > >> reported as such, but if this is a chronic process (especially if the
>> > >> patient has weight loss without signs of infection), it could very
>> > >> well be cancer.
>> > >> 
>> > >> Agree that providing patients access to test reports will help reduce
>> > >> findings falling through the cracks. I read about patient portals on a
>> > >> regular basis - how commonly are they used today?
>> > >> http://meetinglibrary.asco.org/content/120470-140
>> > >> 
>> > >> Another area for improvement is to improve the ease/frequency with
>> > >> which diagnostic specialists and office-based physicians communicate
>> > >> with each other (e.g. direct phone lines).
>> > >> 
>> > >> Multidisciplinary rounds and discussions with referring physicians who
>> > >> drop by the reading room are very helpful in clearing up diagnostic
>> > >> conundrums - however, this mostly happens in the hospital setting.
>> > >> 
>> > >> (cannot tell from Dr. Elias' post if he conveyed his concerns about
>> > >> the reports to the hospital or spoke with the radiologist directly - I
>> > >> hope improving communication would be a goal of all involved in
>> > >> patient care, for many obvious reasons)
>> > >> 
>> > >> 
>> > >> On 24 January 2016 at 16:55, robert bell
>> > >> <0000000296e45ec4-dmarc-request at list.improvediagnosis.org> wrote:
>> > >>> I have suggested that at the same time, or even before we tackle Errors in
>> > >>> Diagnosis, we see that all our support diagnostic tests (Lab, X-ray, etc.)
>> > >>> are in good order so as to help make the correct diagnoses more often.
>> > >> 
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Moderator: David Meyers, Board Member, Society to Improve Diagnosis in Medicine


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