Implementation and outcome assessment of a universal contact email appended to the conclusion of nuclear medicine reports: An accessibility and Quality Improvement initiative.

Objectives: Quality Improvement (QI) is increasingly one of the most important facets of medical care. In July 2017 we initiated automatically appending a standard text string “For report clarification: nucs@ourinstitution.ca” to the conclusion of every finalized nuclear medicine report, thereby incorporating a monitored centralized contact email address. All incoming emails requesting clarification were then promptly triaged by an administrative assistant and redirected to the original reporting attending physician or surrogate when original physician not available. For quality assurance purposes, we have summarized an interim evaluation of the impact of this intervention.

Methods: All relevant inquiries sent to the contact email since inception were reviewed and included in this study. Each inquiry was assessed based on type of procedure, inquiry reason, sender, reporting physician, and eventual outcome. The dates of the initial service, report, inquiry, response and addendum, if any, were recorded. The nature of each query was categorized, for example: request for clarification, typo correction, request for correlation with other imaging, etc. Method of response to each inquiry was tabulated including whether by email or telephone communication and whether an addendum to the initial nuclear medicine report was triggered.

Results: 53 inquiries were received in the email account; 1 was related to a cardiac CTA and misdirected while 4 originated with the filing clerks and did not represent responses to the appended phrase. The 48 remaining inquiries reflect approximately 0.1% of the total number of procedures over the 17-month period. 45 inquiries were from medical services both within and outside of the hospital and 3 originated directly from patients. Interval between reporting and email inquiry ranged between 2-200 days (av. 32.4±45.3 d). Queries arose from across a spectrum of medical diagnoses and services including 21 that were related to a known or suspected diagnosis of malignancy. Most common modalities represented were FDG-PET (n=12) and BMD (n=11). 23 reports involved a trainee dictation, while 25 inquiries were based on a report dictated by the attending staff. 13 inquiries suggested a reporting error, 29 requested clarification or additional information, while 6 were related to a clerical or systemic concern. 16 report addenda were subsequently issued.

Conclusions: Introduction of a standardized contact email, appended automatically to the final impression of the report and moderated by an administrative assistant, facilitated ease of communication between the referring and interpreting physicians. By encouraging feedback from the referring physicians, this service resulted in multiple clarifications with the referring physicians and a total of 16 appended reports. A centralized point-of-contact for all reporting issues also brought to light areas where improvement could be made, such as elimination of ambiguous phrases from within the BMD reporting template, which resulted in recurrent queries. Future QA initiatives include eliciting subjective evaluations from referring and interpreting physicians regarding their experience with this intervention to better improve the service.