Transfer patient imaging: a survey of members of the American Society of Emergency Radiology

Abstract

When trauma patients are transferred from outside hospitals, the receiving clinicians often consult their local radiologists for definitive interpretations of outside examinations (IOE). Such requests introduce a host of logistical, medicolegal, and financial concerns related to quality control and resource utilization. We surveyed 701 members of the American Society of Emergency Radiology to elucidate these concerns. We found that the majority of emergency departments still rely on compact disks for conveyance of outside images; hard film and network transfers were minor mechanisms for most respondents. Sixty-nine percent of the respondents indicated that radiologist reports accompany fewer than 25 % of all transferred imaging studies; of the reports that do arrive, most are unverified preliminary reads. There is considerable variability in billing practices and reimbursement patterns for radiologic second opinions; 68 % of the respondents do not know how often their IOEs are reimbursed. Suboptimal communication between community hospitals and referral centers may result in duplicated efforts and inconsistent quality of medical imaging studies. Further investigation into the role of radiology trainees in the handling of outside studies is also highly recommended.

Appendix

Survey questions

• 1. What is the name of the institution or site of practice where you provide emergency radiology services?

• 2. In what region of the United States is your institution or site of practice located?

  • Southeast

  • Northeast

  • Southwest

  • Northwest

  • Midwest

  • Other (please specify)

• 3. What level trauma center is your institution or site of practice?

  • I

  • II

  • III

  • Other (please specify)

• 4. Does your institution or site of practice have radiology resident-only coverage for part of the day or night?

  • Yes

  • No

  • If so, for which hours?

• 5. Please classify the size of the most immediate metropolitan area:

  • Small

  • Medium

  • Large

• 6. Approximately how often do you receive outside trauma radiology exams?

  • none/rarely

  • 1–3/ day

  • 4–5/ day

  • 6–9/ day

  • 10 or more/day

• 7. Of the outside exams you receive, what percentage are:

  	0–20 %	20–40 %	40–60 %	60–80 %	>80 %
  Network transfer	o	o	o	o	o
  CD	o	o	o	o	o
  Hard copies (film)	o	o	o	o	o
  Other	o	o	o	o	o

• 8. How often do outside exams have accompanying reports?

  • Less than 25 % of the time

  • 25–50 % of the time

  • 50–75 % of the time

  • Greater than 75 % of the time

• 9. What share of the reports that you get are final, signed reports (versus preliminary reports, even if from a telerad service)?

  • Less than 25 % of the time

  • 25–50 % of the time

  • 50–75 % of the time

  • Greater than 75 % of the time

• 10. Do you require these outside imaging studies to be registered in your institution's EMR, PACS, or radiology information systems?

  • Yes

  • No

  • Comment:

• 11. Do you expect the Emergency Department providers to have reviewed the reports on outside exams before you are asked for your opinion?

  • Yes

  • No

  • Please explain.

• 12. How often do you repeat imaging studies on patients who come with outside imaging studies?

  • Always

  • Sometimes

  • Occasionally

  • Never

• 13. What is the most common reason for repeating studies? (Select all that apply)

  • Nondiagnostic study/missing sequences

  • Improper technique

  • To enable billing for interpretation

  • N/A

  • Other (please specify)

• 14. Do you provide reports on outside imaging studies? (Select all that apply)

  • Yes—informal reports

  • Yes—dictated final reports

  • No (please explain)

• 15. Do you bill for the interpretation?

  • Yes

  • No

  • Sometimes (please explain)

• 16. If you bill for interpretation, how often are you reimbursed?

  • Usually (>60 %)

  • Sometimes (30–60 %)

  • Occasionally (<30 %)

  • Never

  • Do not know

  • N/A

• 17. Has your institution or site of practice been the object of litigation as a result of the interpretation of an outside imaging study?

  • Yes

  • No

  • Unknown

  • Prefer not to answer

  • Comment:

• 18. In the event of a discrepancy with the outside report, do you have a mechanism to provide feedback to the outside radiologist?

  • Yes

  • No

  • Unknown

  • Comment:

• 19. Do you feel that the transfer of outside studies is an issue that should be addressed at your institution or site of practice?

  • Definitely

  • Somewhat

  • Minimally

  • No, we have a solution (please explain)

• 20. Does your institution have policies that address the handling and reporting of outside imaging studies?

  • Yes (If so, please explain below)

  • No

  • Please summarize your policies:

• 21. In the space below, please add any additional information that you feel is relevant to this study. We welcome all comments or suggestions for further investigations. Once again, all information gathered is completely confidential with respect to your identity, and the identity of your institution will be coded in the data analysis process. Thank you for your voluntary participation in this study.