AJR: E-workflow management improves critical results reporting
With growing attention focusing on the need for timely and accurate communication of acute or critical radiology results, the department of radiology at Cincinnati Children's Hospital Medical Center created and implemented a "comprehensive customer service system" aimed at improving patient safety and warding off medical-legal charges, according to Alexander J. Towbin, MD, and co-authors from the department of radiology at Cincinnati Children's in Cincinnati.
"Inadequate communication of critical results is the cause of the majority of malpractice cases involving radiologists in the United States. Several studies have shown that a failure of communication is a causative factor in 7 to 80 percent of malpractice lawsuits." The initiative consisted of two parts.
First, the department hired customer service representatives to answer all radiology phone calls as well as to place outgoing calls for the radiologists. The representatives staffed the reading room from 7:00 am to 11:00 pm, seven days per week.
"Second, a novel workflow management system was created to facilitate the day-to-day operations within the radiology department. This workflow management system has multiple functions, including providing a real-time worklist for the reading radiologist, providing a means through which to ask for communication of results, and providing a site to document all communications," the authors continued.
The authors described several benefits to the system. First, using customer service representatives to answer all phone calls freed radiologists to complete medical work, while also making contacting those radiologists more efficient for referring physicians. Furthermore, the authors argued that the "customer service representatives have helped to create a more satisfying work environment and have played a role in radiologist recruitment and retention."
"The key component of creating a comprehensive customer service program was linking the referring clinicians, radiologists, and customer service representatives," the authors continued. By connecting the referring physicians' computerized order entry system with the radiology workflow management system, the referring physicians could indicate which results they wanted immediately communicated, whether positive or negative.
After dictating and signing the reports, the reports appeared on the customer service representatives' worklists. The representatives could then call (or fax) the referring physicians to communicate the results. If the referring physician indicated in the order entry system that he would like to speak with the radiologist directly, the customer service representative would make the call and transfer it over to the radiologist.
In the event that the customer service representative was unable to reach the referring physician via all preferred and alternate telephone numbers, the representative would contact another responsible healthcare provider. All communications and attempted communications were documented in the workflow management system.
"Documentation of these communications has proven critical in multiple cases in which the timing of the communication or even the communication itself has come into question. This documentation has been used to mitigate referring clinicians' complaints about communication failure," Towbin and colleagues wrote.
In addition, radiologists could click an icon on any report that indicated to the representative that the radiologist believed the results should be directly communicated. Moreover, all amended reports, such as reports with additional findings or erroneous diagnoses, would alert customer service representatives for communication to the referring physician.
Between 2005 and 2009, 14 percent of the department of radiology's 828,516 completed studies were communicated to the referring physician and documented in the workflow management system. These results served as the department's definition of "critical" radiology results. No cases were unsuccessfully communicated to either the referring physician or another responsible provider.
Towbin and colleagues expressed their belief that, despite not having completed a cost-effectiveness survey and even with the relatively large cost of additional employees, the customer service system had proven to be cost-effective, primarily by improving the efficiency of radiologists.
The authors concluded that their "creation of a comprehensive customer service program has been crucial in helping our department comply with our duty to notify referring clinicians of critical results. We believe that the method described has not only been cost-effective but has also provided a high level of service to our referring clinicians while at the same time complying with regulatory and legal requirements."