Radiology Bottlenecks - Is There Any Utility of Just in Time Inventory Principles in the ED Setting?
Clin Imaging . 2020 May 13;66:54-56. doi: 10.1016/j.clinimag.2020.04.035. Online ahead of print.
Most budding radiologists emerge from medical school with the excited notion of becoming a “doctor's doctor” [ 1 ]. The role of radiologist has historically been billed as that of a consultant on all things imaging. Radiologists help clinicians and their patients by steering clinicians through the various imaging options and assisting patient care through image interpretation. The practice of sitting down leisurely with a referring clinician to go over the findings of an imaging study, or even better, to get out of the reading room and assist at conferences or on rounds, continues to have great appeal to many of us. However many developments in the field since its inception have resulted in increased commoditization of radiology, and the notion of “radiologist as consult”, though still popular in the abstract, has more or less gone by the wayside [ 2 ]. Clinicians now use appropriateness criteria software to decide which studies they order [ 3 ], and conversations of the appropriate imaging protocol to order have significantly decreased. The volumes of imaging have continued to increase, and many departments and groups promote the idea of 30 min, 1 h or other similarly short turn-around times in order to stay competitive. Teleradiology groups compete for business, affording the opportunity for facilities to receive rapid radiology reporting 24/7; academic centers have in response been pushed to answer with 24/7 attending coverage in order to give ordering clinicians final reports in real time without going outside the organization [ 4 ]. Pushes for simpler structured reporting have lead to increased shoe-horning of diagnoses into standardized boxes. And in the medicolegal arena, the risk of liability for delay of care has pushed the demand for final reads even faster, particularly in the emergency/high acuity settings.
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