Curbside consults: Practices, pitfalls and legal issues

Area of Science:

• Radiology
• Medical Practice Management
• Healthcare Policy

Background:

• Curbside consults, informal physician opinions, are increasingly common in radiology, often involving outside imaging interpretations.
• These consults, especially for complex cases, carry risks due to time constraints and incomplete information, potentially leading to misinterpretations.
• The practice has shifted from discrete question responses to comprehensive over-reads, raising questions about current policies and physician perspectives.

Purpose of the Study:

• To assess the current policies and prevailing views on curbside consults at academic radiology centers in the United States.
• To identify potential risks and challenges associated with informal radiology interpretations.
• To provide recommendations for minimizing errors and liability in curbside consults.

Main Methods:

• An online survey was distributed to 319 active radiologist members of the Association of Program Directors.
• A total of 80 responses were received, yielding a response rate of 25%.
• The survey focused on practices, perceptions, and concerns regarding curbside consults.

Main Results:

• Most institutions (92%) offer second reads, but few (23%) provide written reports or perform complete over-reads.
• A majority (77%) tailor interpretations to specific clinical questions, and many (approx. two-thirds) do not require prior outside reports.
• Physician concerns about liability are significant (79%), and billing practices for these consults are inconsistent (45% bill, 39% unaware).

Conclusions:

• Curbside consults are prevalent in U.S. academic radiology departments, yet formal documentation remains uncommon.
• Widespread concern exists regarding legal implications, necessitating strategies to mitigate patient care errors and reduce liability.
• Recommendations are proposed to enhance the safety and accountability of curbside consults.