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Advice on Unread overnight inpatient exam
So one of partners on call asked me if I could do him a favor and read that an inpatient MRI that was not read for 24hrs because it was it was put into the queue of one of my MSK partners by the another call person last night. That MSK radiologist was not working today so I guess that is why it was not read.
The ordering clinician was upset because it was not read, and called at the end of the day and that is how I got involved.
I ended up reading it and of course it was positive. Now I am worried if I should have even read it or if I should have not gotten involved.
Advice? Has anyone ever been in a similar position and what would you do?
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10 Replies
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Positive in what way, like florid septic joint with soft tissue abscesses , osteo etc or like a sacral insufficiency fracture.
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Urgent but not life threatening.
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I usually put in a statement that says something along the line of “I was made aware of the study and images were submitted for interpretation at ? hr.” in the technique section. This is for me to remember what happened in case an argument comes up. In that case, I can recall exactly who did what and what study was dumped. Sometimes I make a note to myself and put it in a drawer in my office just in case I will forget. Ideally, if there’s an urgent finding I would call the referring and explain the situation, ie I was not on call and only made aware of the study right now, that’s why I am calling you. If he have a problem with it, he will have to take it up with the chair or whoever is in charge of radiology. Ultimately, it was the fault of the dumper, not yours. Just make sure to get your story straight.
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Yeah, tough situation especially if you are more junior person. Agree with comment in the end of technique section (that wont get read unless it turns into big deal) about when you were made aware of the exam (20 minutes before reading it out…)
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Wanted to add that referring clinician/service also responsible for following up in a timely manner.
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Perfect. That’s great advice. Thank you.
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‘Study became available for my review on x/y/zz @ 1735h. Results reported to Dr Livid by phone on x/y/zz @ 1755h.’
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I agree with the “I was made aware” or in technical situations “the study was made available for dictation” etc
This comes up with the whole “I need to get this guy off my census!” which is usually Saturdays (esp. in academic resident run) and the follow up for routine studies would be the same since there is nothing emergent. Why don’t they just discharge the patient and follow – as they are going to do if they have a read or not? Instead, rads get a bothersome call on something not urgent or emergent, even.
Why do the clinicians care if it doesn’t matter or change management?-
Read it and document the circumstance. That way you are part of the solution, not perpetuating the problem, if there are recriminations.
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Quote from Casino Royale
I agree with the “I was made aware” or in technical situations “the study was made available for dictation” etc
This comes up with the whole “I need to get this guy off my census!” which is usually Saturdays (esp. in academic resident run) and the follow up for routine studies would be the same since there is nothing emergent. Why don’t they just discharge the patient and follow – as they are going to do if they have a read or not? Instead, rads get a bothersome call on something not urgent or emergent, even.
Why do the clinicians care if it doesn’t matter or change management?
Because they are worried if there is a positive result they will be on the hook.
There is often a place to make “notes” that are not part of the medical record. You should clearly document what happened, without implicating anyone, how you got involved.
“I was called at home when I was not scheduled to work at x time and date and immediately read the study”
Don’t delay patient care because you are worried it may reflect poorly on you.
OR Don’t answer the phone. When you’re off you’re off; your call.
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