RSNA: Communicating critical results requires improved measures
CHICAGO—Ramin Kharasani, MD, of Brigham and Women’s Hospital in Boston, opened the Communicating Results session at the Radiological Society of North America (RSNA) annual conference yesterday with a discussion on the implementation of improved solutions and measures in regards to communicating critical results between radiologists and referring physicians.

In attempting to implement improved communication, there are safe practices and functional requirements that must be abided by, said Kharasani. The aforementioned safe practices address the optimal communication of critical information, leading to diagnosis.

To begin with, radiologists must accurately identify their targets, or the responsible physicians that must receive the critical information, said Kharasani. This includes selecting which office the information must be sent to, if the doctor has more than one practice.

“There are a lot of complex issues around responsible physicians,” stated Kharasani. The idea of the responsible physician entails who would need to be next on the list of contacts to communicate with should the first referring physician be out of the office, at another location or otherwise unreachable, he explained.

Perhaps the most significant issues in the communication of results, according to Kharasani, are that most practices have yet to incorporate patients into the communication loop and the general timeliness in which critical test result information is conveyed between physicians.

Kharasani proposed that the best way to approach the passing-on of critical information is for healthcare facilities to adopt a standardized approach. This approach can be determined within each healthcare facility, and must measure, assess and, if necessary, take action to improve the timeliness of reporting and the timeliness in which the referring physician receives critical results.

“[The measure of the timeliness of communication] cannot be qualitative, it must be quantitative,” said Kharasani.

Result stratification was another position Kharasani pointed out as a topic to be considered by healthcare facilities looking to implement critical communication standards.

“Not all critical results are the same,” he said. Defining what conditions qualify as critical is an important step in the reporting of critical results.

As of December 2005, Brigham and Women’s Hospital implemented a color scheme, designed to stand as alert levels for critical information.

Kharasani explained the colors as signifying “a new and unexpected finding that could result in mortality or significant morbidity if appropriate follow-up steps were not taken.”

The color red stands for a high-priority result, which must be communicated to the patient in less than 60 minutes from the time of discovery via telephone or face-to-face communication. Orange is the next priority level.  A result falling into this category requires a three-hour closure on communication. This information can be communicated by any form that can be confirmed in absolute terms that it was received -- email or faxes are examples of unacceptable modes. A result that receives the color yellow is said to be not immediately life-threatening and the communication loop must be closed within three days.

In closing the communication loop, documentation is critical, said Kharasani. Physicians must document who, what and when the communication took place, and implement this into the medical record.

“Whatever we do has to be measureable, because we can’t improve what we can’t measure,” he said.

Moreover, Kharasani stated that documentation must be monitored by the leaders within the healthcare setting, and the documentation must be easy, secure, and HIPAA compliant.

Kharasani stressed that there is no single IT solution or application that will solve the problems associated with the delivery of critical results between radiologists and referring physicians to their patients.

“We cannot wait for the technology to develop. We need to act now,” he concluded.