Polytrauma-CT

Polytrauma-CT: Demonstrably higher quality of findings and shorter reporting time – the University Hospital Dresden relies on synoptic reporting

 The University Hospital Carl Gustav Carus Dresden is a maximum care hospital with more than 1,400 beds, 26 specialist clinics, and 17 interdisciplinary centres. The Institute and Polyclinic for Radiological Diagnostics provide the hospital with the complete spectrum of diagnostic imaging and therapeutic interventional procedures. The Institute and Polyclinic for Diagnostic and Interventional Radiology at the University Hospital Carl Gustav Carus Dresden is a renowned institution that offers a wide range of services and provides state-of-the-art imaging and interventional procedures.

Dr. med Sophia Blum is a specialist in radiology and senior physician at the Institute and Polyclinic for Diagnostic and Interventional Radiology. She is a Q2-certified musculoskeletal radiologist. Since 2020, Dr. Blum, who holds an additional qualification in medical quality management, has been employing the structured reporting solution provided by Smart Reporting for routine reporting on polytrauma cases. Since the beginning of 2022, more than 2,500 reports have been created in Dresden using Smart Reporting’s documentation software.

"We introduced the reporting solution from Smart Reporting as part of a quality improvement project. The primary goal was to standardize the structure of the reports, aligned with the needs of the trauma team," explains Dr. Blum. Before adopting the synoptic reporting with Smart Reporting, the university hospital already used a predefined structure within the report. However, the assessment was written in free text form. Additionally, there was no uniform classification for injuries, resulting in a lack of comparability in the generated reports. Particularly among younger colleagues, there was a risk of overlooking something or leaving specific questions about particular regions unanswered.

Reporting Requirements: Quick Orientation and Targeted Capture of Pathologies

The requirements set by the radiology department in Dresden for synoptic reporting with Smart Reporting were as follows: All users should be able to quickly orientate themselves in the written report, systematically capture relevant pathologies, and memorize the content well – a crucial factor for the residents. Therefore, special attention was given to the development of the report template using the Template Creator of Smart Reporting's reporting software. The template was created and refined in close collaboration with all disciplines involved in polytrauma care. All classifications used in the template were also discussed with the referring physicians. The report template, including info boxes and illustrations, created using the Template Creator, resulted in a precise decision tree. This facilitated a practical fracture classification, a clear categorization of organ injuries, and an organized and comprehensive report.

Especially for younger colleagues and the target audience of referrers, the introduction of synoptic reporting brought many advantages: "Among the residents, structured reporting is very popular. It provides guidance on which regions need to be examined. Furthermore, it offers many opportunities to acquire structured knowledge through the info boxes," says Dr. Blum. The feedback from referrers was consistently positive in personal conversations as well. Additionally, the reports created with the reporting software from Smart Reporting, especially within the user group of residents, were generated faster and with higher quality than before. "For us, this meant that synoptic reporting has the potential to bring about process improvement in daily routine Polytrauma-CT, reducing reporting time and errors while enhancing referrer satisfaction. We wanted to scientifically support these conclusions," explains Dr. Blum.

Comprehensive Evaluation of Reporting Time and Quality through a Study

From September 2020 to June 2021, all CT polytrauma patients aged 18 and older were included in the study. The reporting time and reporting errors were recorded three months before the introduction of structured reporting and during the first six months after its implementation in clinical practice. The creation of CT primary reports was conducted by both residents and specialist physicians. Referrer satisfaction was assessed before and after the introduction through a survey using a five-point Likert scale. By comparing the results before and after the introduction, an attempt was made to objectively quantify the impact of synoptic reporting on polytrauma CT in a university hospital.

The results of the study confirmed the essential findings: With the documentation software from Smart Reporting, reporting was faster (65 minutes vs. 87 minutes), and after four months, the median reporting time was significantly shorter. As a result, the proportion of reports completed within one hour increased from 55.1% to 68.3%. Additionally, there were fewer reporting errors, both among residents and specialist physicians. Another outcome was increased satisfaction among referrers. They praised the standardization of reports, the report structure, and the accessibility of crucial pathologies.

"These results have affirmed our belief that the implementation of synoptic reporting is a step towards greater efficiency and higher quality in reporting. This is important for various reasons - one of them being that we have a relatively high number of new residents. They undergo an extended period of training before working independently in the emergency department. With synoptic reporting, we aimed to introduce a mechanism that reduces reporting errors. The Colleagues achieve the specialist standard within two and a half years and then independently generate polytrauma reports, for example, during night shifts," explains Dr. Blum.

Introduction phase with many feedback rounds and improvements to the template

The greatest advantages of synoptic reporting come to fruition when ideally all reports to be created are structured using the template. This means convincing all users to utilize the software. Therefore, at the University Hospital Dresden, the introduction of synoptic reporting was linked to a comprehensive change management process. During the six-month introduction phase, monitoring of the usage of the reporting template took place. The utilization rate of the template increased significantly in the first three months, reaching 96 percent. "Then we experienced a decline, which had various causes, including further adjustments to the template. Applying the template to multiple or complex injuries was particularly challenging for many colleagues. It was important for us to respond to these concerns in a targeted and prompt manner," Dr. Blum elaborates on the introduction period.

In the first year, the content was constantly adjusted and subjected to feedback rounds. Initial difficulties and possible reservations were discussed in leadership rounds and objectified through data from monitoring. "Subsequently, the use of the software increased again, and the templates are now used 100 percent. The residents also tell us that they don't want to create reports in any other way anymore. They simply feel more confident with it. This is a very gratifying development," further explains Dr. Blum.

Additional templates were developed - primarily by residents

Subsequently, further templates were developed at the University Hospital Dresden to expand synoptic reporting to areas beyond polytrauma CT. Currently, the reporting solution from Smart Reporting is used, for example, for CT interventions such as biopsies and drainage procedures. Other applications include guideline-compliant synoptic reporting of pancreatic carcinoma in MRI and CT, as well as the staging diagnosis of breast carcinoma in MRI. Currently, reporting using Smart Reporting's documentation software for hip MRIs and specific interventional findings is being rolled out - often with residents as the main drivers.

"I observe a great deal of enthusiasm among the younger colleagues. In many institutions, they are developing reporting templates and thus driving forward structured reporting. This also has a significant impact on clinical routine," says Dr. Blum. Clinical routine is simplified, for example, by the automated incorporation of important pathologies into the assessment. An example from practice: Colleagues no longer have to manually enter ante- or retro-torsion into the assessment during torsion measurement. Instead, it appears automatically in the report section depending on the measured values and according to clinical considerations. Dr. Blum: "As has happened with pancreatic carcinoma or rectal carcinoma, increasingly structured reports are expected from us in radiology. Accordingly, we will work more with structured reports in the future, possibly across different institutions."

For the future: AI support in the detection of injuries

In the radiology department of the University Hospital Dresden, the use of Smart Reporting's reporting solution and synoptic reporting has translated into higher report quality with simultaneous reduction in reporting time – these findings were substantiated by a study involving polytrauma CT patients. Residents benefit from increased confidence in reporting and solidify their knowledge and skills with Smart Reporting's reporting software. Through an extensive change management process, the utilization rate of the reporting software has been brought to 100 percent and is now employed in multiple areas.

For the future, Dr. Blum envisions progress in the automated detection of specific, life-threatening conditions through the use of Artificial Intelligence (AI) or Machine Learning: "Especially in polytrauma reporting, the factor of time plays a significant role in patient outcomes. Automated detection using AI - for example, for liver laceration, active bleeding, dislocated spinal fractures, or intracranial bleeding - just to name a few examples - that can be quickly transferred would be fantastic." In the current software generation, Smart Reporting has already implemented the incorporation of results from AI algorithms. This area will be further expanded in the coming months.