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Curbside consults: Practices, pitfalls and legal issues

  • Sowmya Mahalingam
    Correspondence
    Corresponding author.
    Affiliations
    Department of Radiology and Biomedical Imaging, 330 Cedar Street, Yale University School of Medicine, New Haven, CT 06520, United States of America
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  • Author Footnotes
    1 Present address: USC Keck School of Medicine, Department of Radiology, 1500 San Pablo St, 2nd Floor, Los Angeles, CA 90033, United States of America.
    Nitya M. Bhalla
    Footnotes
    1 Present address: USC Keck School of Medicine, Department of Radiology, 1500 San Pablo St, 2nd Floor, Los Angeles, CA 90033, United States of America.
    Affiliations
    Department of Radiology and Biomedical Imaging, 330 Cedar Street, Yale University School of Medicine, New Haven, CT 06520, United States of America
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  • Jonathan L. Mezrich
    Affiliations
    Department of Radiology and Biomedical Imaging, 330 Cedar Street, Yale University School of Medicine, New Haven, CT 06520, United States of America
    Search for articles by this author
  • Author Footnotes
    1 Present address: USC Keck School of Medicine, Department of Radiology, 1500 San Pablo St, 2nd Floor, Los Angeles, CA 90033, United States of America.

      Highlights

      • Curbside consults are informal opinions rendered by one physician to another.
      • Curbside consults are not without liability and therefore documentation is key.
      • Radiologists should make a practice of documenting their opinions.
      • Key documentation includes the impression and the limitations of interpretation.
      • Academic practices can bill a professional fee for re-interpretation.

      Abstract

      Objective

      “Curbside consults” are informal opinions provided by one physician to another. In radiology, it often refers to opinions rendered on imaging performed at outside facilities and has evolved from being a targeted response to a discrete clinical question to a complete over-read in recent years. Given that the consults are usually sought for patients with complex conditions, the potential for error increases with informal reads, often due to the time constraint and lack of adequate information. Misinterpretations and inaccurate documentation by the referring clinician are also more likely. This study assesses the policies and views on curbside consults at academic centers in the United States.

      Materials and methods

      An online survey (via SurveyMonkey.com) was circulated to the 319 active radiologist members of the Association of Program Directors. There were 80 responses, representing a 25% response rate.

      Results

      While most facilities provided second reads (92%), only a few (23%) provided written reports and read the case entirely. The majority (77%) tailored their read to answer specific clinical questions. Approximately two-thirds did not require the outside radiologist's report to be available before their interpretation. Seventy-nine percent were at least mildly concerned about liability. Up to 45% billed for the study; 39% were not aware of the billing practice.

      Conclusion

      Curbside consults are widely provided at U.S. academic institutions with only a minority documenting their opinions. The majority are concerned about the legal implications and this paper puts forth recommendations to minimize the potential for errors in patient care and decrease liability.

      Keywords

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