Timely radiology reporting supports efficient care by enabling shared decisions when imaging and clinic visits occur on the same day. Patients often choose this arrangement for convenience and to reduce anxiety, yet radiologists typically read examinations in the order they are completed, without visibility of upcoming clinic appointments. This can delay report availability at the point of care. An information technology intervention at a large academic medical centre and an affiliated cancer centre sought to close this gap by using clinic appointment times to reprioritise the reading order for diagnostic imaging linked to same-day outpatient visits. The initiative assessed whether actionable communication would be available when patients arrived for their clinic appointments and examined operational factors that may influence timeliness.
Targeting Same-Day Appointments with Real-Time Queueing
The intervention was implemented in January 2021 across 21 clinics with high volumes of same-day imaging and clinic encounters, comprising 8 sites at the academic medical centre (AMC) and 13 at the cancer centre. Radiologist worklists were dynamically reprioritised based on the time remaining to a patient’s scheduled same-day outpatient visit, with examinations grouped into less than 4 hours and 4 to 8 hours before the appointment. Radiologists were asked to read examinations sequentially from this reprioritised list.
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A retrospective comparison included diagnostic imaging for patients with related same-day clinic visits during two three-month windows: preintervention from 1 October 2020 to 31 December 2020 and postintervention from 1 October 2023 to 31 December 2023. After applying exclusions for unrelated visits, unique workflows and non-radiologist final signers, the final sample comprised 6,391 preintervention encounters and 8,025 postintervention encounters. Cancer centre clinics accounted for most encounters, and oncology was the predominant ordering specialty, followed by surgery. CT was the most common modality. Thoracic radiologists interpreted more examinations than any other division.
The primary outcome was availability of actionable communication at the time of the clinic appointment. Actionable communication was defined as a preliminary or final report or a closed-loop alert of critical or urgent results to the referring provider using an existing tool. Secondary measures examined the relationship between the time from examination end to clinic appointment and whether actionable communication was available, and described the mean and 80th percentile intervals from examination end to clinic arrival postintervention. Statistical testing included a χ² test for availability differences between periods and an independent-samples t test for time comparisons.
Significant Gains in Actionable Communication
The proportion of encounters with actionable communication available at the clinic appointment increased after the intervention. Postintervention, 56.2% of encounters (4,513 of 8,025) had actionable communication available at the scheduled appointment time compared with 45.2% preintervention (2,889 of 6,391). This represented a 24.3% improvement, with postintervention encounters significantly more likely to have actionable communication available at clinic arrival (χ² [1, n = 14,416] = 172.9, odds ratio 1.56, P < .001).
Time intervals between the end of imaging and the clinic appointment were closely linked to availability. Among postintervention encounters, the mean time from examination end to clinic appointment was 156.5 minutes when actionable communication was available at clinic arrival, within a range of 11 to 635 minutes. When actionable communication was not available, the mean interval was 79.9 minutes, within a range of 0 to 435 minutes. The difference between these means was significant. Across all postintervention encounters, the average time from examination end to clinic arrival was 123.0 minutes and the 80th percentile was 198 minutes.
Additional descriptive findings contextualise the case mix and workflow environment. Trainees were present on 46.8% of preintervention reports and 35.4% of postintervention reports. Closed-loop communication alerts were sent in 6.8% of preintervention encounters and 5.7% postintervention. Most postintervention encounters were ordered by cancer centre providers, aligning the intervention with a setting where result timeliness is particularly relevant for therapy assessment and planning.
Operational Considerations and Limitations
Although the intervention increased the likelihood that actionable information was available at the clinic appointment, more than one-third of prioritised reports remained unavailable at patient arrival. The observed association between longer imaging-to-clinic intervals and higher availability highlights operational levers outside the worklist itself. Adequate radiologist staffing and ensuring sufficient time between imaging and clinic visits are important considerations to improve availability at the point of care. It is also possible that allocating attention to same-day appointments after the intervention influenced turnaround for examinations without same-day visits.
The initiative sits alongside prior efforts to accelerate reporting through worklist changes, including technologist-driven urgency classifications and subspecialised reporting models that have been associated with shorter turnaround times. In contrast, this approach uses scheduled clinic appointment data from the electronic health record to reprioritise reading order specifically for same-day pathways, offering a complementary mechanism to improve result availability at the moment decisions are made.
Several factors limit interpretation. The analysis was retrospective, non-randomised and single-centre. It is unknown whether similar gains would be realised across other specialties, facilities or regions. Actual provider-patient meeting times were not available, so measuring against scheduled appointment times may have underestimated availability if some reports became ready after the encounter started. The work did not assess patient satisfaction or directly measure whether shared decision making improved as a result of earlier availability. Given that patients often travel or adjust work and family commitments for care, the timeliness of imaging results remains a salient operational and experiential consideration, but formal evaluation of patient-reported impact was beyond scope.
Using clinic appointment times to reprioritise radiologist worklists for same-day imaging and outpatient visits was associated with higher availability of actionable communication at the point of care. The improvement observed alongside clear time-dependency suggests that combining intelligent queueing with sufficient intervals between imaging and clinic appointments and appropriate staffing can support timely information exchange. While more than one-third of prioritised reports were still unavailable at arrival and generalisability remains untested, the findings indicate that IT-enabled worklist reprioritisation can help align reporting workflows with clinical schedules and may add value to decision making during same-day pathways without altering interpretive standards. Further operational refinement and broader evaluation could clarify how best to scale this approach across services where report timeliness is critical.
Source: Journal of the American College of Radiology
Image Credit: iStock
