Structured feedback from referring physicians: a novel approach to quality improvement in radiology reporting

There is considerable interest in improving radiology reporting practices through peer review, and the inclusion of structured feedback from referring physicians may improve this process. The purpose of this article is to evaluate the feasibility of this type of novel peer-review system.

Five referring physicians from our institution participated as reviewers. Reports from abdominal CT, chest CT, brain MRI, and abdominal ultrasound were eligible for review if the indication was "abdominal pain," "shortness of breath," "headache," and "pain," respectively. Reports were excluded if the examinations were normal or ordered as follow-up. Forty-eight reports (12 from each group) were then selected at random and distributed to the referring physicians along with the clinical scenario and an evaluation form for each examination.

The reports were found to be clinically useful (average, 3.8 on a 1-5 scale), allowing for good confidence in clinical decision making (average, 3.7). The most common problems were unclear language, typographical errors, and reports that did not answer the clinical question. Of the reports, 35.4% contained recommendations for further diagnosis or treatment, and 84.7% of these recommendations were deemed clinically appropriate. The participating physicians thought that the results of 31.2% of the examinations should have been directly communicated to the ordering provider.

Radiology reports and recommendations were clinically useful, even though problems with language, typographical errors, answering the clinical question, and direct communication of examination results were identified. Structured feedback from referring physicians is a novel approach to the peer-review process that may identify problems that go unnoticed by the radiologist, thereby improving reporting practices.