If you’re a radiologist, chances are at some point in your career you’ve cherry-picked the worklist. But picking easy, high-RVU imaging studies to read before your colleagues isn’t just rude – it’s bad for patients and bad for healthcare.
That’s according to a new study in Journal of Operations Management that analyzes radiology cherry-picking in the context of operational workflow and efficiency.
Based on previous research, researchers hypothesized that radiologists who are free to pick from an open worklist would choose the easier studies with the highest compensation – the classic definition of cherry-picking.
To test their theory, they analyzed a dataset of 2.2M studies acquired at 62 hospitals from 2014 to 2017 that were read by 115 different radiologists. They developed a statistical metric called “bang for the buck,” or BFB, to classify the value of an imaging study in terms of interpretation time relative to RVU level.
They then assessed the impact of BFB on turnaround time (TAT) for different types of imaging exams based on priority, classified as Stat, Expedited, and Routine. Findings included:
- High-priority Stat studies were reported quickly regardless of BFB, indicating little cherry-picking impact
- For Routine studies, those with higher BFB had much lower reductions in turnaround — a sign of cherry-picking
- Adding one high-BFB Routine study to a radiologist’s worklist resulted in a much longer increase in TAT for Expedited exams compared to low-BFB studies (increase of 17.7 minutes vs. 2 minutes)
- The above delays could result in longer patient lengths of stay that translate to $2.1M-$4.2M in extra costs across the 62 hospitals in the study.
The findings suggest that radiologists in the study prioritized high-BFB Routine studies over Expedited exams – undermining the exam prioritization system and impacting care for priority cases.
Fortunately, the researchers offer suggestions for countering the cherry-picking effect, such as through intelligent scheduling or even hiding certain studies – like high-BFB Routine exams – from radiologists when there are Expedited studies that need to be read.
The study concludes that radiology’s standard workflow of an open worklist that any radiologist can access can become an “imbalanced compensation scheme” that can lead to poorer service for high-priority tasks. On the positive side, the solutions proposed by the researchers seem tailor-made for IT-based interventions, especially ones that are rooted in AI.