RSNA: Auto alert system improves safety, patient care

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CHICAGO—The use of an automated alert system to communicate critical radiology findings successfully alerted referring physicians within a median time of 3 minutes and improved compliance with notification guidelines threefold, according to a study presented today at the 96th annual scientific meeting of the Radiological Society of North America (RSNA).

Previous to the implementation of the Alert Notification of Critical Radiology Results (ANCR) at Brigham and Women's Hospital (Boston), all critical radiology findings (red, orange and yellow) required paging of referring physicians, often interrupting the physicians during surgical procedures. The referring physicians complained that the volume of these critical findings was too high, especially given that critical findings that required no immediate changes in patient care (code yellow) demanded the same responsiveness from clinicians as life-threatening findings.

In response, the department of radiology at Brigham and Women's Hospital began using ANCR, integrating the software program into the hospital's PACS, explained Ramin Khorasani, MD, MPH, vice chairman of radiology at Brigham and Women's Hospital. The system required radiologists to generate alerts by tagging critical findings according to their level (color) of urgency. PACS filled in all demographic information on the patient as in a normal report and the radiologists could finalize their reports after generating alerts but before receiving responses from the clinicians.

All critical findings were then stored on a separate radiology worklists, enabling the radiologists to continue reading or reporting on other cases while monitoring the status of the alerts. Radiologists could track which findings had not been received, who the referring physicians were, the times of the exams and reports, as well as all other details of the findings.

Red and orange alerts automatically paged the referring physicians and required responses by either phone or direct consult. Yellow findings were sent to referring physicians via email, with receipts generated by the clinicians' logging into ANCR. After radiologists either communicated directly with or received receipt notifications from the referring physicians, they would then check off on the worklist that the critical findings had been communicated.

After reviewing several months worth of ANCR compliance, Khorasani found that the percentage of the 1,000 monthly critical findings that radiologists communicated according to the hospital's guidelines increased from 25 percent to more than 90 percent. The median time for acknowledgement of critical findings by referring physicians measured 3 minutes.

Two percent of all critical findings reported with ANCR were tagged as code red, and 100 percent of these findings were successfully communicated according to hospital guidelines. Orange findings, accounting for 30 percent of critical reports, met with 97.5 percent compliance, with most of the remaining results communicated a few minutes after deadline. Median acknowledgment of yellow findings by referring physicians fell within a couple of hours.

Khorasani reported high satisfaction with the automated system, as usage among radiologists has grown from 11 percent to 30 percent since implementation. According to Khorasani, the take home point is that not overwhelming referring physicians with critical but non-emergent findings can optimize the communication of critical results and thereby improve patient safety.