Design and implementation of a new radiology consultation service in a teaching hospital.

The steady increase in costs related to testing has been a major factor in the overall growth of health care expenses. Concern is substantial about the excessive number of tests ordered by physicians without measurable improvement in patients' outcomes. This is of particular concern in teaching hospitals, because in addition to the direct impact on national health care expenditures, these are the institutions in which young physicians train and formulate test-ordering practices. Proper selection of imaging tests is a complex process that requires detailed information about the patient; specific questions to be answered; and knowledge of the characteristics of the test, including sensitivity, specificity, risks, and cost. To date, no systematic method exists for combining the expertise of the radiologist with that of the referring physician before the tests are selected. Therefore, we designed a new clinical service within the radiology department that allows formal, on-the-ward consultation to assist internal medicine housestaff in the selection of radiologic tests. The goal of this study was to assess the feasibility of this formal radiology consultation service and to determine how often its imaging recommendations were implemented for patients with complicated medical conditions.