title: Radiologists' responses to inadequate referrals.
abstract: OBJECTIVE
  To investigate radiologists' responses to inadequate imaging referrals.
  
  
  METHODS
  A survey was mailed to Norwegian radiologists; 69% responded. They graded the frequencies of actions related to referrals with ambiguous indications or inappropriate examination choices and the contribution of factors preventing and not preventing an examination of doubtful usefulness from being performed as requested.
  
  
  RESULTS
  Ninety-five percent (344/361) reported daily or weekly actions related to inadequate referrals. Actions differed among subspecialties. The most frequent were contacting the referrer to clarify the clinical problem and checking test results/information in the medical records. Both actions were more frequent among registrars than specialists and among hospital radiologists than institute radiologists. Institute radiologists were more likely to ask the patient for additional information and to examine the patient clinically. Factors rated as contributing most to prevent doubtful examinations were high risk of serious complications/side effects, high radiation dose and low patient age. Factors facilitating doubtful examinations included respect for the referrer's judgment, patient/next-of-kin wants the examination, patient has arrived, unreachable referrer, and time pressure.
  
  
  CONCLUSIONS
  In summary, radiologists facing inadequate referrals considered patient safety and sought more information. Vetting referrals on arrival, easier access to referring clinicians, and time for radiologists to handle inadequate referrals may contribute to improved use of imaging.
authors.affiliation: Faculty of Health Sciences, Oslo University College, P.O. Box 4 St. Olavs plass, NO-0130, Oslo, Norway. kristin.bakke-lysdahl@hf.hio.no
authors.forename: Kristin Bakke
authors.initials: KB
authors.lastname: Lysdahl
authors.forename: Bjørn Morten
authors.initials: BM
authors.lastname: Hofmann
authors.forename: Ansgar
authors.initials: A
authors.lastname: Espeland
mesh_terms: D001291:Attitude of Health Personnel; D016009:Chi-Square Distribution; D003657:Decision Making; D006801:Humans; D009664:Norway; D010820:Physicians / Q000523:psychology*; D010818:Practice Patterns, Physicians' / Q000706:statistics & numerical data*; D011871:Radiology; D012017:Referral and Consultation / Q000592:standards*; D011795:Surveys and Questionnaires