Scientific Session 12 — SS12: Gastrointestinal Imaging - Diffuse Liver DiseaseWednesday, May 8, 2019
2782. Non-Imaging Recommendations in the Radiology Report: Our Experience With Referrals to a Specialized Fatty Liver Clinic
Negrete L*, Obeid R, Hahn M. University of California San Diego, San Diego, US
Address correspondence to L. Negrete (email@example.com)
Objective: Recommendations provided in radiology reports may include suggestions for follow-up imaging or nonimaging investigations, clinical correlation, and referral to appropriate specialists. Studies have shown overall poor adherence to follow-up recommendations stated in radiology reports. Prompted by existing management guidelines for non-alcoholic fatty liver disease (NAFLD), radiologists at our institution often recommend referral of patients with a new imaging diagnosis of fatty liver to a subspecialized NAFLD clinic. The primary purpose of this study was to retrospectively determine if ordering providers adhere to radiologist recommendations for patient referral to a NAFLD clinic. A secondary purpose was to elucidate possible explanations for incomplete compliance with referral recommendations in order to inform future quality improvement interventions.
Materials and Methods: This was a single-institution, IRB-approved retrospective study. A database query of all abdominal US, CT, and MRI reports between January 2008 and January 2018 identified abdominal imaging reports that documented a new imaging diagnosis of fatty liver and a simultaneous recommendation for NAFLD clinic referral. Retrospective chart review determined the frequency of patient referrals by ordering providers to the NAFLD clinic within a 3-month timespan following the recommendation in the imaging report. Data were stratified by imaging modality (US, CT, or MRI), context of imaging examination (ED, inpatient, or outpatient setting), and specialty of ordering provider.
Results: In total, 169 radiology reports with a new imaging diagnosis of fatty liver and simultaneous recommendation for referral to the NAFLD clinic were identified, consisting of 77 ultrasound, 84 CT, and 8 MRI reports. Overall, referrals to the NAFLD clinic by ordering providers were completed by ordering providers for 59 patients (35%). When stratified by modality, all 8 patients in the MRI group were referred, 36 patients (47%) in the US group were referred, and 15 patients (18%) in the CT group were referred. In subgroup analysis of the US group, the majority (58%) of providers who referred patients to the NAFLD clinic were family medicine specialists. Of the 41 participants (53%) not referred to the NAFLD clinic in the US group, their ordering providers included 63% who were either inpatient internal medicine physicians, emergency physicians, or inpatient trauma surgeons.
Conclusion: Following receipt of abdominal radiology reports that demonstrate a new diagnosis of fatty liver, there is overall poor ordering-provider compliance with radiologist-recommended patient referrals to a subspecialized NAFLD clinic. Notably, the rate of compliance to recommended NAFLD clinic referrals by ordering providers varies with imaging modality, with greater adherence to recommended referrals made in MRI and US reports than in CT reports. Ordering provider practice location and clinical specialty also affect the rate of referral. Further follow-up will examine these interrelated findings to identify interventions to increase referral rate most efficiently.