|Year : 2021 | Volume
| Issue : 1 | Page : 18-23
Radiology request form: Evaluating its complete filling in South-South, Nigeria
Ebbi Donald Robinson1, Olukumni Yetunde Ijeruh1, Woroma Wonodi2, Rufus Abam1, Chidinma Wekhe1
1 Department of Radiology, Rivers State University Teaching Hospital, Port Harcourt, Rivers State, Nigeria
2 Department of Paediatrics, Rivers State University Teaching Hospital, Port Harcourt, Rivers State, Nigeria
|Date of Submission||02-Dec-2020|
|Date of Decision||30-Jan-2021|
|Date of Acceptance||28-May-2021|
|Date of Web Publication||22-Jun-2021|
Ebbi Donald Robinson
Department of Radiology, Rivers State University Teaching Hospital, Port Harcourt, Rivers State
Source of Support: None, Conflict of Interest: None
Introduction: Radiology request form (RRF) is a medical referral to a radiologist requesting input concerning the diagnosis, treatment, follow-up of patients, and intervention where necessary. The RRF usually provides information on the patient(s) and the investigation(s) being requested. Methodology: This was a cross-sectional descriptive study, in which request forms were retrospectively reviewed over a period of 6 months in the Radiology Department of the Rivers State University Teaching Hospital. A total of 1131 request forms filled by medical doctors were analyzed to ascertain the degree of completeness of filling the forms. The data were collated and analyzed using the IBM Statistical Package for the Social Sciences version 23. The results were expressed in simple percentages, frequencies, and presented in tables, charts, and graphs. Results: Ultrasonography was the most requested radiologic investigation (55.4%), while X-ray and computed tomography scan account for 41.4% and 1.1%, respectively. Majority of the forms had adequately entered date of request (97.7%) and required investigation and patient's names (99.6%). Patient's age was appropriately entered in 51.9% of cases, while 34.1% kept the space blank. Clinical information was indicated in 50.8% of the forms, while 97.2% did not include history of patient's allergy as regards the use of radiopharmaceutical agents. The patient's consultant and resident's doctor names were appropriately entered in 72.1% and 81.7% of the request forms, respectively. Signature authentication by the resident doctor is available in 13.2% of the request forms. Conclusion: It was observed that majority of the RRFs were not completely and appropriately filled; thus, complete information regarding the patient is not provided to the radiologist to enhance report accuracy. Clinical information if adequately provided can improve the quality of patient management, follow-up, training, and research.
Keywords: Clinical information, radiology request form, Rivers State University Teaching Hospital, ultrasonography
|How to cite this article:|
Robinson ED, Ijeruh OY, Wonodi W, Abam R, Wekhe C. Radiology request form: Evaluating its complete filling in South-South, Nigeria. J Radiat Med Trop 2021;2:18-23
|How to cite this URL:|
Robinson ED, Ijeruh OY, Wonodi W, Abam R, Wekhe C. Radiology request form: Evaluating its complete filling in South-South, Nigeria. J Radiat Med Trop [serial online] 2021 [cited 2022 Jan 24];2:18-23. Available from: http://www.jrmt.org/text.asp?2021/2/1/18/319114
| Introduction|| |
Radiology request forms (RRFs) contain requests made by a licensed medical doctor for radiological investigations on patients. RRF is actually considered as a medical referral to a radiologist requesting for the radiologist's input concerning the confirmation of diagnosis, treatment, follow-up of patients, and patient intervention where necessary. RRF is an effective two-way communication between the requesting medical doctor and providers of the services offered by the radiology department. RRF should be completely, adequately and legibly filled to avoid misunderstanding of the investigation and possible misinterpretation of results. The importance of adequate completion of RRF by medical doctors cannot be overemphasized, and the importance of proper documentation in these forms is usually emphasized early in the physicians' training. The RRF usually provides information on the patient(s) and the investigation(s) being requested for. Absence of clinical information can have serious postanalytical errors such as inappropriate interpretative comments;, it can also result in medical errors or delay in institution of appropriate treatment, which can significantly impact ultimately on patient safety and outcome., The writing should be legible/readable in clear handwriting for easy extraction of information, and only medically known and accepted abbreviations should be used if at all necessary. Legible is defined in the dictionary as capable of being read or deciphered, especially with ease.
Different institutions adapt different formats for their request forms. In the Rivers State University Teaching Hospital (RSUTH), the RRF contains information in four sections, namely the patient's demographic details, the investigation(s) being requested for, the requesting physicians' details, and the type of radiographic cassette used in the case of radiographic investigation [Figure 1]. The patient's details include name, age, sex, ward/department, phone number, address, last menstrual period (LMP), folder number unique to the patient, clinical information, and diagnosis, while the investigation details include the specific investigations being requested for and date of the request. The physicians' information section contains the doctor's name, signature, and consultant in charge of the patient. The signature of the requesting doctor authenticates the request. Other relevant details include previous surgeries, previous X-rays, and history of allergy. The history of previous exposure to ionizing radiation is very important to avoid frequent exposures, which may be harmful to the patient. The radiologist may suggest another equally useful imaging modality that does not utilize ionizing radiation and is able to answer the clinical question to be answered.
|Figure 1: The radiology request forms of Rivers State University Teaching Hospital|
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Some investigations such as computed tomography (CT) scan and magnetic resonance imaging (MRI) may require the use of contrast medium, and if a history of allergy is provided, the radiologist takes it into cognizance and an alternative is sought. Been an effective two-way communication between the requesting medical doctor and the services provider being the radiologist, no space was provided for the referring physician's phone number, in the event where the radiologist needs to contact the physician.
Inadequate filling of RRF is a global problem. The degree of complete filling of RRF differs from one geographic location to another, from one facility to another, and over time. Different studies have audited the complete filling of RRF by doctors, and quite a number of them revealed a suboptimal level of completion of RRF. An audit of 580 RRFs by Akintomide et al. showed that most completed request forms were 86.6% filled while the least completed were 26.67% filled. In another study by Afolabi et al., out of 202 RRFs, only 89.1% had complete and adequate information. Agi et al. in Port Harcourt concluded that different aspects of radiological forms are incompletely filled, with the name of the consultant being the least filled (only 81.3% of the forms contained the name of the consultant). A retrospective study in Lagos University Teaching Hospital also revealed important omissions in RRF. In a prospective study in three facilities across three nations (Nigeria, Ghana, and Sierra Leone), the most common omissions were age of the patients, followed by the absence of clinical information and illegible entries.
The way to improve the quality of information on RRF is by periodically reminding the requesting physicians to ensure that all columns are appropriately and diligently filled out. A clinical audit is also another approach to improve the quality of patient care, including diagnostic and therapeutic radiological care. The present study was, therefore, an audit of the complete filling of RRF in RSUTH. The understanding of the pattern of filling of RRF will be helpful in designing intervention programs to enhance the complete filling of RRF.
| Methodology|| |
The study was conducted in the Radiology Department of the RSUTH, Nigeria. The RSUTH is a 375-bedded state-owned tertiary health institution that offers specialized healthcare in different departments such as Pediatrics, Obstetrics and Gynecology, Internal Medicine, Surgery, Family Medicine, Pathology, Radiology, Physiotherapy, and Nursing. The radiology department has state-of-the-art equipment and conducts investigations such as ultrasonography, MRI, computerized tomography, and X-rays. The radiology department serves the hospital and other health facilities, government and private-owned, within and outside Rivers State. The radiology department is composed of radiologists, radiologists in training (residents), radiographers, technical unit, and attendants.
Ethical approval for this study was obtained from the Ethics Committee of the RSUTH, and permission to assess the RRF was granted by the Head of the Radiology Department in RSUTH. The study was a cross-sectional study in which the RRFs were retrospectively reviewed from January 2020 to June 2020. A total of 1131 request forms were analyzed to ascertain the degree of completeness of filling the requested details containing 19 components. Only requests made using the appropriate RSUTH RRF were analyzed. The requests that were not made with the hospital's request forms were excluded from the study.
The aspects of the audit for complete filling included folder/hospital number, surname, other names, age, sex, unit number, ward/clinic, address, date, phone number, clinical summary/diagnosis, resident doctor's name, resident doctor's signature and consultant's name, LMP (where applicable), walking/wheelchair, previous surgery, previous X-rays, allergy as well as legibility of writing, and the appropriateness of requested investigation.
Data were collated and analyzed by the researchers using the IBM Statistical Package for the Social Sciences (SPSS) windows version 23.0 statistical software (SPSS Inc, Chicago, Illionois, USA). The results were expressed in simple percentages, frequencies, and presented in tables, charts, and graphs.
| Results|| |
Radiologic investigations are one of the most common investigations requested by clinician for the diagnosis, treatment, and follow-up of patients. Analysis of available data shows that out of the 1131 request forms evaluated, ultrasonography was the most requested radiologic investigation accounting for 55.4% (n = 627), while X-ray, MRI, and CT scan accounted for 41.4% (468), 2.1% (24), and 1.1% (12), respectively [Table 1] and [Figure 2].
The gender (sex) of the patients was appropriately documented by 94.87% (1072), whereas 5.13% (58) of the clinicians did not indicate the gender [Figure 3]. According to [Table 2], majority of the clinicians adequately entered the date of investigation (97.7%, 1105), patient's surname (99.6%, 1127), and patient's other names (99.5%, 1125). Concerning the ward/clinic of the patients, 7.6% (86) did not enter this information in the request form [Table 2].
|Table 2: Whether the date, surname, other names, and ward/clinic were appropriately entered in the request form|
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Concerning the appropriate entering of patient's age, 51.9% (587) entered the age of the patients appropriately, while 34.1% (386) kept the space blank, whereas 12.3% (139) and 1.7% (19) indicated adult and child, respectively, as shown in [Figure 4]. This revealed cumulatively that approximately 48.1% of the clinicians do not append their patient's age in the investigation forms.
|Figure 3: Request forms with patients' gender (sex) appropriately indicated|
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|Figure 4: Whether patient's age was appropriately entered in the request form|
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Address of patients was not indicated for 79.1% (895) of the patients, while 9.5% (108) of the clinician wrote the phone numbers of the patients [Table 3]. Majority of the clinicians indicated the required investigation (99.2%, 1122), whereas 0.8% (9) did not write the required investigation, as also shown in [Table 3]. The presence of the clinical information and the appropriateness of the clinical information in relation to the requested information were also evaluated. As shown in [Table 3], 50.8% (745) of the clinicians indicated the clinical information regarding the requested investigation, whereas in 49.2% (557) of cases, the clinical information is either not available or incomplete, or not completely informative or inappropriate for the investigation requested for.
|Table 3: Whether patient address, phone number, clinical information, and examination requested were appropriately entered in the request form|
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The LMP is of immense importance regarding the obstetrics and gynecologic history of female patients. LMP was not applicable to 51.19% of the patients, which includes men, elderly women, and children, as shown in [Figure 5]. Women of menstrual age constituted 48.81%, of which 62.32% of them had the LMP indicated while 37.68% did not have the LMP indicated [Figure 5] and [Figure 6].
|Figure 5: Whether patient's last menstrual period was applicable or not applicable|
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|Figure 6: Whether patient last menstrual period was appropriately entered in the request form|
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[Table 4] shows information regarding previous X-rays/reports, allergies, as well as unit/folder number. According to [Table 4], 97.3% (1100) did not include information regarding previous radiologic investigation or reports and 97.3% (1101) did not indicate patient hospital or unit folder number. Similarly, 97.2% (1099) did not include a history of allergy of the patients as regards the use of radiopharmaceutical agents. The patient's consultant name and the resident's doctor name were appropriately entered in 815 (72.1%) and 81.7% (924) of the request forms, respectively [Table 4]. However, the resident doctor's signature authentication was not available in 13.2% (149) of the request forms [Table 5]. History of previous operations and whether the patient is ambulant or on wheelchair or trolley were not indicated in 95.8% (1083) and 94.3% (1066) cases, respectively, as shown in [Table 5]. Majority (95.1%, 1076) of the forms were legible to read and understand, as also shown in [Table 5].
|Table 4: Whether information regarding previous X-rays/report, allergies, unit/folder number, consultant's name, and resident's doctor name were appropriately entered in the request form|
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|Table 5: Whether information regarding previous operations legibility of written walking/chair/trolley/theater/bedside resident's doctor signature were appropriately entered in the request form|
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| Discussion|| |
An RRF is actually considered as a medical referral to the radiologist, requesting the radiologist input in the confirmation of diagnosis, treatment, follow-up of patients, and patient intervention. The results obtained from the study show that ultrasonography was the most requested radiologic investigation during the study duration. This could be attributed to the fact that ultrasonography does not use ionizing radiation,, and it is readily available and relatively cheaper when compared to other imaging modalities.,
A patient's name is the first line of proper identification of the patient., Patient identification is very essential for the managing physician for properly documentation of investigation and treatment. Majority (99.6%) of the clinician entered the names of the patients in the appropriate column. This finding is similar to that documented by Afolabi et al., Agi et al., and Irurhe et al.
The percentage of clinicians that correctly filled the age of the patient was slightly above average (51.9%), whereas 34.1% of the clinicians did not indicate the age of the patient and kept the space blank. Some of the clinicians indicated either adult or child instead of the actual age in Arabic numerals. This finding in the index study is lower than that documented by Agi et al. in their study with 300 request forms. In the study by Agi et al., 86.3% of the request forms have the patient's age well documented, and the variation could be due to difference in the number of forms evaluated (sample size) and may also be due to degree of proper supervision of the doctors. These patients whose ages were not indicated cannot be appropriately categorized as pediatrics or adult patients. This may pose a diagnostic challenge as age plays a vital role in imaging.
Concerning the indication of patient's gender (sex) in the index study, 94.87% of the clinicians documented the gender of the patients in the request form. This occurrence is similar to the result obtained in the study by Agi et al., where 97.3% of the request forms have the gender of the patient documented.
Residential addresses of the patients were not indicated in 79.1% of the request forms. This finding is similar to the result documented by Agi et al. In their study, 89.7% had no residential address indicated in the forms. Lack of residential address may be a great challenge for contact tracing and in a case where a repeat study is needed for further radiologic evaluation of the patient.
A minority of the clinicians accounting for about 0.8% did not indicate the actual investigation requested for. This is not different from the finding by Akintomide et al. where 0.34% did not indicate the radiologic investigation requested. The reason for this cannot be conjectured. However, it may be attributed to negligence, poor knowledge of radiologic imaging modalities, and workload or a slip of the pen as most of the request forms are filled by either house officers or younger medical doctors.
Approximate half of the doctors did not enter the clinical information and the appropriateness of the clinical information in relation to the requested investigation. The clinical information helps the radiologist to have a better understanding of the clinical context of the patients and therefore very pertinent in radiologic interpretation of images., Other clinical information such as LMP, allergies, and previous X-rays/report was not entered in majority of the request forms. History of previous operations and whether the patient is walking or wheelchair or trolley were also not documented in most of the request forms. The study “The effect of clinical information on radiology reporting: A systematic review” revealed that there is a positive impact on the quality of radiologic reports with the documentation of clinical information. The noninclusion of the clinical information in the RRF may be due to assumption that the radiologist is also a doctor and should know the presenting complaints. It may also be attributed to poor knowledge of the role clinical information play in radiologic image interpretation. Improper completion of the forms may be due to the ironical fact that some of the doctors do not know their patient.,, It can also be attributed to pressure at work and excessive workload, which could impair concentration and proper filling of the forms.,
It is therefore imperative for medical practitioners to provide adequate and complete information regarding the patients. Proper documentation could enhance effective patient management, follow-up, training, and research.
| Conclusion|| |
It is observed that majority of the RRF were not completely and appropriately filled; thus, complete information regarding the patient is not provided to a radiologist to enhance report accuracy. The importance of adequate completion of the RRF by medical doctors cannot be overemphasized. The provision of all the necessary information to the radiologist will enhance more effective and efficient radiologic image evaluation. Hence, this information can improve the quality of patient management follow-up as well as training and research.
It is recommended that every RRF should be appropriately and completely filled, and the writing should be as legible as possible. The goal is to improve the quality of patient care through radiologic reports, with the need for effective education of younger medical practitioners on the complete filling of the radiologic request forms and the inclusion of a space for the phone contact of the referring doctor for effective communication.
Financial support and sponsorship
Conflicts of interest
There are no conflicts of interest.
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[Figure 1], [Figure 2], [Figure 3], [Figure 4], [Figure 5], [Figure 6]
[Table 1], [Table 2], [Table 3], [Table 4], [Table 5]