By A.J. Watson

Worklist cherry-picking in radiology is a practice that can have serious consequences on patient care. When radiologists have access to open worklists—giving them the option to choose which imaging studies to read first—certain cases are given priority, even over expedited exams.

Imaging studies that are easier or more routine in nature, tied to higher compensation rates, or are more interesting often get read first, which undermines the exam-prioritization system. And despite years of efforts by healthcare organizations to combat it, a new study reports that hospitals are still struggling with radiology worklist cherry-picking.

Beyond compromised patient care, cherry-picking presents an issue for management, sometimes resulting in major workflow problems and decreased efficiency. Diagnoses take longer and are at risk of being missed altogether, resulting in incorrect treatments being prescribed, which can cause complications—or even death—in extreme cases. Additionally, when workflows are jumbled, it may lead to orders for unnecessary or redundant imaging studies, and the additional costs associated with them can quickly add up for both patients and healthcare institutions.

Staffing Shortages Build Pressure to Cherry-Pick

Staff shortages, burnout, and stress-filled work environments have contributed to the continued problem of worklist cherry-picking, sometimes leaving radiologists feeling like they have little choice. A never-ending stream of exams can be overwhelming and demotivating for radiologists.Time constraints, busy schedules, and the need to handle numerous cases during a single shift have led to prioritizing simpler and quicker-to-read studies over more complex or challenging ones.

Certain healthcare institutions prioritize the quantity of cases reviewed, overlooking the time taken for analysis and the intricacies involved, like patient age and exam type. If the structure prioritizes speed above all else when gauging the highest return per hour of work, that places radiologists in an unfair position and fails to consider all the nuances of the job.   

Finally, if there is no unified workflow in place that assigns tasks evenly across all members of a team or department, it may become possible for some employees to gravitate toward specific types of cases or acquire preferential access to certain categories of scans. Without effective monitoring systems in place, these types of imbalances can go unnoticed and unchecked with damaging effects on health outcomes. 

As a result, it’s essential for medical imaging departments to implement strategies that prioritize quality patient care and improved outcomes by creating fairer policies and utilizing new technologies. 

The Best Workflow Solutions Reduce Issues, Increase Job Satisfaction

Fortunately, there are proven solutions that prioritize quality patient care and improved outcomes. Implementing worklists that present radiologists with the work they should read, sorted according to the priorities of the radiology group or healthcare organization they serve, is a solid first step. When putting more effective workflows into place, it’s essential to evaluate the worklist’s design, how radiologists will be credited for their work and supported in competing non-reading tasks, and how data can inform radiologists and improve the process.  

There are several approaches to designing specific lists for radiologists. For instance, every healthcare system has days or times of the day when they experience an influx of exams or some shifts get behind on important cases. An overflow worklist can be used to “call in the troops” when additional help is needed and can also be placed at the top of a shift’s reading queues—only activating when overflow conditions are met. 

For example, if urgent cases are not dealt with rapidly enough, the reading responsibility of those exams can be automatically expanded to include more readers, increasing the odds of getting it read quickly. Also, the usefulness of context-aware worklists based on physician specialty, credentials, workload, location, and availability cannot be overstated. These features allow specific exams to be assigned to certain people or teams.

Shift specificity within a list defines the type of work that needs to be read by the radiologists covering a shift. It can be driven by a variety of needs, including workstation software requirements and availability as well as geographic and location-specific parameters, which should result in an expected reading workload adjusted to match the reality of that location. 

Case in point: If a radiologist on a particular shift is continually needed to answer questions for the techs in the adjacent room, that radiologist should preferentially read the studies for that location. Another scenario may entail a radiologist working at an image-acquisition site being assigned many non-reading responsibilities, warranting a reduced reading workload or even the need to assign specific cases to a remote employee who can focus on reading responsibilities as part of a regular workload.

Aside from optimizing worklist design, it’s important for radiologists to be properly credited and recompensed fairly for their efforts. Often, relative value units, or RVUs—which are commonly used to assess workloads—do not accurately capture radiologists’ productivity. So, assessing non-reading tasks and contemplating a time-based option are essential.

This starts by defining work unit credits specific to a practice, which can be accomplished by creating modality-specific default values and by modifying existing relative value units to better match a practice’s objectives. Utilizing a worklist design that permits radiologists to manually give themselves RVU or WU credits for non-reading tasks is an option that saves time and fairly documents all facets of an imaging professional’s job. After collecting data for several weeks, practices can use it to calculate work value units per exam based on time-in-dictation statistics.

Simplify Things Across the Board and Enhance Productivity

Solutions that offer an auto-next feature save radiologists time by auto-launching the next exam on their worklist, allowing them to read exams from a selected worklist one after the other, without having to separately open each exam from a list. The feature enables an estimated 50% more efficiency, as radiologists can trust it to present the most appropriate examination for immediate reading and they never have to return to the worklist.

For example, the cloud-based Clario SmartWorklist intelligently distributes exams through a singular, comprehensive access point, regardless of the complexity or disparate nature of a radiologists’ reading environment. A study of efficiency and quality associated with usage of the solution revealed a 32% gain in productivity and an error rate that declined from 0.77% to 0.37%.

In the end, organizations also must take care to measure performance equally and by the same standards across the board, so everyone receives credit appropriately without feeling marginalized or undervalued. Additionally, systems and protocols should be implemented to ensure accurate assessments, save practitioners time, and facilitate timely and convenient communication between radiologists, clinicians, administrators, and other stakeholders.

By taking these steps to discourage radiologist worklist cherry-picking practices, healthcare organizations can ensure that quality patient care is always prioritized, thus paving the way for overall improved outcomes. They also stand to benefit from increased savings due to enhanced efficiency, a boost in team morale, and better staff retention.

AJ Watson is chief product officer of Intelerad Medical Systems. Questions and comments can be directed to [email protected].