Critical test-result management systems help reduce malpractice suits

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CHICAGO—Legal, ethical and moral obligations to ensure results of the 12 billion annual hospital tests in the United States are appropriately communicated can be delivered through the utilization of health IT and critical test-result management (CTRM) systems.

Michael Matthews, director of clinical information systems in the department of diagnostic radiology at Yale-New Haven Hospital in New Haven, Conn., shared his experiences with CTRM in a narrated electronic poster presentation at the 2009 Healthcare Information and Management Systems Society (HIMSS) conference.

According to Matthews, Yale-New Haven Hospital is a 944-bed tertiary-care institution comprising 2.8 million square feet in 12 buildings in and around New Haven. It has 3,500 affiliated physicians, 7,500 employees and conducts approximately 500,000 radiology exams each year.

The scope of the institution is on track to grow even larger, with the 14-storey Smilow Cancer Center scheduled for opening this coming December. It will include 112 inpatient beds, 12 operating rooms, radiology services, infusion suites and a women's cancer center and represents Connecticut's largest healthcare construction project.

"The radiology procedures are expected to double (to nearly 1 million annually) when Smilow is fully online," Matthews said.

With its thousands of healthcare professionals, large geographic area and multitude of exams, Yale-New Haven must have timely delivery of critical-test results for quality patient care.

"Of malpractices cases, 25 percent are diagnostic related and 75 percent are communication related," Matthews noted.

Yale-New Haven elected to deploy a CTRM system (Veriphy, Nuance Healthcare) in order to meet National Patient Safety Goal 2C from the Joint Commission: "Measure, assess and, if appropriate, take action to improve the timeliness of reporting, and the timeliness of receipt by the responsible licensed caregiver of critical tests and critical results and values."

In addition, given the radiology department's exam volume, the manual process of reporting critical findings to physicians and tracking results reporting was becoming unworkable.

"There are some challenges to rolling out an automated solution that replaces a more personal, manual one," Matthews noted. "It is by no means an easy sale for everyone. Referring and ordering clinicians have to get used to a message to their cell phone, pager or fax instead of a call from our radiology department."

The CTRM system does not replace all face-to-face communication and phone calls, Matthews emphasized. Instead, it is often used to initiate a more in-depth conversation. The most important element of CTRM deployment is that test results are delivered consistently to the ordering clinician.

"The implementation of our CTRM system has had a positive impact on patient care and patient safety," he said.