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Meet the Consultant Diagnostic Radiology May 28, 2019

Outline • • Review Consultation Process Optimization Diagnostic Radiology Consult pearls

Goal of Consultation Process • Patient centered and highly reliable • Respect referral lines • Facilitate communication between requestor and consultant – address pain points on each side

Classic article on Consult Etiquette

Effective Consultations 1) 2) 3) 4) 5) 6) 7) 8) 9) 10) Determine the Question Establish Urgency Look for Yourself Be as Brief as Appropriate Be Specific Provide Contingency Plans Honor Thy Turf (or Thou shall not covet thy Neighbors Consult) Teach…With Tact Talk is Cheap…and Effective Follow up *= Primary team *= Consultant *= Shared responsibility

Optimizing the Consult Process

Example of Updated Consult Order

Connect Center • • • Staffed by paramedics; they are expert at making connections Will contact appropriate provider based upon who consult service wants contacted (i. e. resident, fellow or attending) Staff and available 24/7

Current State (5/2019) • • As of February 2019 all inpatient consults services are live for ROUTINE consult requests Over 34, 682 consult connections since December 2017

Dashboard – currently in Beta Testing

Important Points • This process is for all ROUTINE consults • Type the specialty (ID, Psych, ESRD, GI etc) in the “To” field (Do NOT click the magnifying glass) • 24/7 for ROUTINE consults • STAT consults will continue to be called in • Mobile Heartbeat Dynamic roles are being created • This is an iterative process and we welcome feedback

Questions or comments Clinical. Redesign@ynhh. org

Meet the Consultants Diagnostic Radiology May 28, 2019 Anish Gonchigar, MD

What we do Diagnostic imaging Image-guided procedures

Radiology services • Body (Abdominal) • MSK (Bone) • Breast • Cardiac • Chest • Emergency • GI/GU • Neuro • Nuclear • Pediatrics • Ultrasound • IR*

Imaging facilities • Inpatient • • • York Street Campus Saint Raphael Campus Milford Hospital Bridgeport Hospital VA* • Outpatient • • • Shoreline Devine Street (North Haven) Long Wharf Park Avenue Norwalk

How to order studies • Timing • • Life Threatening: Stroke, Code, etc. STAT: within an hour Urgent: within 4 hours Routine: everything else • Protocoling studies • Contrast

http: //www. svuhradiology. ie/diagnostic-imaging/ct-2/

http: //www. svuhradiology. ie/diagnostic-imaging/ct-2/

IV contrast • • Helps a lot! Contraindications • • • GFR < 30 ESRD patients who make > 10 cc urine per day Anaphylaxis • No gadolinium cross reaction • IR can use CO 2 instead

Oral contrast • • BMI < 25 Post-op bowel surgery, fistula, Crohn’s disease IV contrast contraindicated (poor renal function) Pediatric patients

Premedication policy

Premedication order set

Premedication order set

Other policies • • Pregnancy test (10 -55 yrs) IV access requirement Pacemaker POC Creatinine Search “Yale premedication policy” https: //medicine. yale. edu/diagnosticradiology/patientcare/policies/

Consults

Useful numbers • Ballroom: 688 -8811 York Street ED Triage: 688 -6180 SRC ED Reading Room: 789 -3929 Neuroradiology off-hours: 200 -3181 • IR pagers • • • YSC: 203 -370 -0915 SRC: 203 -766 -7581

Night/Weekend Nuclear or GI/GU • Only for emergent indications • Call ED Triage (688 -6180) to coordinate • Needs a nurse/provider to accompany the patient • Nuclear Medicine • VQ scan • HIDA scan • GI/GU • Esophagram

Importing outside studies • Image Library Contact: radiologycustomersrvice@ynhh. org 203 -688 -8812

Importing outside studies • Image Library Contact: radiologycustomersrvice@ynhh. org 203 -688 -8812

Importing outside studies • Image Library Contact: radiologycustomersrvice@ynhh. org 203 -688 -8812

Outside interpretations • Provide reason, specific clinical question, outside read (if available) • If planning to repeat study, no need for second interpretation

Effective communication • Scheduling • Outpatient • 688 -1010 • Inpatient/ED • 688 -8811 (Ballroom) • 688 -6180 (ED Triage) • Expediting studies/timing • Technologists/scheduling for US • Questions on what to order and reads • Reading rooms

Effective communication • When to call us • If you have questions • Urgent/emergent clinical settings • Errors in the report that need addendum • How best to help • Provide accurate history and clear question • Give us time to review the study after scanning • Please discuss IR procedures with patients before ordering!

Want to learn more? • Radiology elective rotations • PACS trainings through Radiology IT • Radiology Grand Rounds • Useful Websites: • • https: //radiopaedia. org http: //www. radiologyassistant. nl http: //headneckbrainspine. com https: //www. acr. org/Clinical-Resources/ACR-Appropriateness-Criteria

Social media @yaleradiology Yale Radiology and Biomedical Imaging

Road 2 IR: Tanzania IR Initiative @road 2 ir

Questions? ydr. chiefs@yale. edu

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