Use of a Macro as Nudge Factor in Communication Between Radiologists and Referring Physicians

Introduction/Methods: Radiologists provide value through communication of imaging findings. We outline a quality improvement effort using a dedicated dictation macro as a behavioral nudge to increase direct communication between radiologists and referring physicians. Use of the macro was encouraged by departmental leadership and publicised widely prior to implementation. Monthly data regarding the use of the macro and corresponding departmental volumes were acquired over a 24 month period. Results: Over the 24-month study period, there were 1,334,555 total exams performed and 52,276 total communications (3.90%; monthly range 2.21-4.67%). The greatest increase in adoption rate occurred during the initial 4-month period, with sustained rates of communication achieved after month 4. Results were more frequently communicated to a clinician when a resident trainee was involved in the dictation process. The greatest number of documented communications was for x-ray, followed by Computed Tomography (CT), Magnetic Resonance Imaging (MRI), Ultrasound (US), and nuclear medicine. Inpatient studies (7.23%) were communicated at a statistically significantly higher rate than Emergency Department (ED) (3.86%) or Outpatient (OP) studies (1.31%), P < 0.0001 for all comparisons. The rate of documented communication steadily increased across all patient classes. Conclusion: Our findings demonstrate that simple interventions to increase the rate of documented communication can have durable results, and highlight the critical role radiologists play in timely and effective patient care delivery. Introduction of a communication macro coupled with departmental nudges resulted in increased direct communication of imaging results. This effort has promoted mutual engagement between radiologists and their colleagues, and demonstrates the active role of radiologists in direct imaging consultation.