Why Your Studies Get Rejected

Radiology services has moved into the age of digitalization and mobile servicing. Now it is faster, easier, and more reliable than ever to get your patient scans read by top radiologists from around the country through the use of teleradiology.

However, even with the speed and advanced technological capabilities afforded by teleradiology, you may find that your studies are being rejected and sent back to your facility. Why does this occur? And, more importantly, what can you do to avoid this from happening in the future?

Why it Matters: Delayed TAT for Your Scans & Decreased Patient Care

When you team up with a teleradiology service provider, or switch providers, there is often a re-education that must occur when it comes to workflow.

  • How are the studies getting from your facility to the provider and back again?
  • What protocols are in place to ensure all of the necessary data is included?
  • What processes exist to manually retrieve missing data?

Having the answers to these questions will create a productive and harmonious relationship between your facility and the teleradiology provider. But, even with a solid process in place, there are still some common mistakes that can delay the TAT for your completed read. Even for teleradiology companies that promise quality and speed, like Premier, some contractual agreements do not apply until the provider has received a completed study.

We find that approximately 10% of the scans we receive are missing critical information. This is due to a focus on quantity over quality, which only leads to substandard patient care and the risk of your TAT being pushed back by hours as we manually track down the required information to complete the read.

For each of the following mistakes that cause a study to be rejected, it is simply a matter of taking the time up front to follow protocol, provide quality images, and relay the necessary information to get a quality report for your patient.

4 Common Mistakes You Can Easily Avoid

1.Missing Geographical Information

If we don’t have the geographical information for your facility, we cannot even begin the process of a read. Radiologist are required to carry a valid state license in each state they work. So, if we do not know what state the images were taken in, we cannot assign the scans to the proper radiologists. Upkeep of licensure is costly, so not every radiologist will carry the same set of licenses. Some have only a few while we employ others who have as many as 40.

The physician who will complete the report entirely depends on this geographical information, without it we must begin the manual process of tracking it down or you will have to reprocess the entire order.

This is a simple step that can jam up the workflow and push back the TAT. However, the following 3 reasons your study may get rejected have more to do with a risk of decreased patient care and of increased liability risk for the teleradiology company.

2. Missing Clinical Information

For each order we receive, we also need to have the following information in order to provide the best care. This information may come from the attending nurse, physician, or x-ray technician (list in no particular order):

  • Symptoms/Clinical Reason for Exam: Such as a pre-employment physical/screening vs. an acute injury.
  • Length of Symptoms: Days, weeks, months?
  • Mechanism of Injury: Did the patient fall? Did something fall on the patient? Did something hit the patient? Etc.
  • Point of Pain Marker:Should be designated on the x-ray images as an indicator of where the pain is located on the patient.
  • Prior exams: Are there prior exams done at this facility? This information is important because we need to make sure the workflow for these studies is being pushed as we will no longer be the archive and past studies will be purged within 48 hours of being read on our servers.
  • Priority of Study: STAT versus ROUTINE. While this may not mean it is rejected, workflow is created based off this priority so your client SLA may not be met if this data point is missing.
  • Ultrasound Tech Sheet: If an ultrasound, we need an ultrasound tech sheet that includes 2D diagrams and a protocol to follow for each study type.

Other radiology practices may still give you a read despite missing the above information. But, at Premier, we value quality patient care and we cannot ensure that quality without these data points. However, we recognize that all systems don’t allow you to input this much detail. In the event that you are not able to enter this type of information in your source system, Premier can offer you access to our system and enter the information via our workflow to self-clarify cases.

3. Image Quality / Missing Images or Views

If you scan is of a non-diagnostic quality, or if it is standard views or other critical images, we cannot complete the study and the report must be reprocessed.

  • Poor Image Quality: Factors such as patient body habitus, weight, etc. are all additional factors that have to be considered when completing the imaging exam with the appropriate amount of radiation. Otherwise, images will appear to be washed out and have no clinical use.
  • Industry Standard Views: Based on the diagnosis/reason for exam there are specific “industry standard views” that are required for the radiologist to give a definitive report. If a view is not taken, a note should be added as to why. The reasoning could be as simple as the patient was experiencing to much pain or was not cooperative. Another example: Asking the patient to hold a tennis ball or gauze wrap to allow the radiologist to more directly see if there are fractures in the wrist that cannot be as easily seen when there is no engagement.

4. Images Improperly Cropped or Labeled

  • Imaging Cropping: For focused views, cropping the field of view needs to be done before they are sent to the radiologists. Radiologist are responsible for anything on the image, whether it should be there are not, so studies are rejected that do not have the correct cropping so as to not take on increased liability for the teleradiology provider.

Example of improperly cropped images. The areas in yellow should be cropped before pushing to your teleradiology provider.

  • Image Labeling: If a bilateral exam or a single sided exam is ordered, the images should have the proper R or L marker on the images.If this standard step is somehow skipped, the physician cannot give a proper diagnosis.

Patient Focus = Patient Care

Focus on one patient at a time and follow the protocol for taking and sending images in order to avoid the above mistakes. In doing so, you are playing your part in providing optimal patient care. The more detailed information provided by the patient care team will allow our staff and radiologists to provide your patients with a more specific directive of care based on acuity of the studies being presented.

We understand the challenges of being in the field and the distractions that occur under the burdensome push for speed over quality, but by incorporating these guidelines into your protocols you will improve patient satisfaction and care.

If you want to connect with our operations team about workflow or to discuss other challenges that may not have been mentioned above, please contact us.