In the Nick of Time: Communicating Critical Results
In radiology, acquiring the image is only part of the job. Effective communication of image data is key, particularly in urgent cases. Communication of critical radiology results has wide-reaching implications, from patient safety to regulatory compliance.

The Joint Commission has emphasized the reporting of critical results since 2004, when the National Patient Safety Goal 02.03.01, requiring important test results to be provided on time to the correct staff person, was created.

Many organizations have turned to an automated critical results reporting system to meet this goal. Whether developed in-house by providers or by a vendor, these tools interact with systems such as RIS or PACS, and transfer information to relevant physicians through automatic emails, text messages or voicemails. A major benefit of these systems, in addition to the increased speed that comes with automation, is many allow for detailed audits or timelines. Data can be checked against target benchmarks to give a practice a sense of how effective their communication processes are, and then inform quality improvement initiatives.

To understand how Health Imaging readers handle critical results reporting, we conducted an online poll from July 11-31 asking radiologists, IT staff and administrators how their organizations manage critical results reporting, and what features they require in an automated system.

Half of the respondents said they used an automated system, with the rest generally relying on phone calls from radiologists to the ordering physician with the time and date of calls noted manually on the report. Most automated reporting systems were created by third parties; a mere 8.3 percent of respondents indicated they use an internally developed system.

8 Recommendations from The Joint Commission
Whether or not an organization has implemented an automated system, a detailed critical results reporting strategy needs to be put in place. To this end, The Joint Commission Journal on Quality and Patient Safety published a list of eight recommendations for success. They are:

1. Polices should be introduced with clear definitions of key terms.

2. Policies should clearly outline provider responsibilities.

3. Policies should specify procedures for fail-safe communication of abnormal test results.

4. Policies must define verbal and/or electronic reporting procedures for both critical and severely abnormal lab, imaging and other test values.

5. Policies should specify critical tests and the acceptable length of time between ordering and reporting.

6. Policies should define timelines between the availability of test results and patient notification, and organizations should specify preferred mechanisms for patient notification.

7. Policies must be of “real-world” value and written with feedback from key stakeholders.

8. Policies should establish responsibilities for monitoring and evaluating communication procedures.
Of the facilities using an automated reporting system, 88 percent use a system that provides multiple levels of alerts. The systems offer standard communications such as email and voicemail messages, and 63 percent of systems used by survey respondents also allow for critical results to be viewed from a smartphone or tablet device.

Respondents listed their top two reasons for developing a critical results reporting strategy. The mantra “safety first” appears universal. All respondents selected “patient safety” as one of their top two motivators. One-third also selected Joint Commission compliance, the second most-cited reason.

From STAT to superSTAT

One advantage to developing an automated system in-house is that it can be customized to fit a department’s needs. Staten Island University Hospital in Staten Island, N.Y., customized its vendor-developed reporting system by creating a “superSTAT” category for the emergency department (ED). Since all ED imaging exam requests are designated as STAT, the department needed a way to indicate which exams were for critically ill patients—cases of suspected stroke or pulmonary embolism, for example—and required an even quicker turnaround time, explains Conor M. Lowry, MD, radiology resident.

These superSTAT cases are automatically recognized by the system and appear in gray text in the worklist to differentiate them from other exams and let the radiologist know they are in the process of being performed. Once the exam is completed, the superSTAT cases are bumped to the top of the worklist and marked with an icon to indicate they need to be interpreted quickly.

Losing touch

As with most disruptive technologies, while automated critical results reporting solves one problem, it potentially creates another in the form of reducing personal contact between radiologists and referring physicians. In a Masters of Radiology discussion published in the April 2010 issue of the American Journal of Roentgenology, Marcia C. Javitt, MD, of Walter Reed Army Medical Center in Washington, D.C., wrote this shortcoming “may well jeopardize our significance in the healthcare loop and further ‘commoditize’ our efforts as procedure-based subspecialists.”

Lowry, too, is reluctant to delegate all communication to an automated system. His department’s system could automatically contact physicians to let them know exams have been read, but he prefers to call himself and use a digital timestamp on the report, “I like to talk to the person. I want to make sure it got through because I don’t know if I trust [an automated message].”

Relying on the phone has its own issues,  as one survey respondent noted that “the biggest downside to this methodology is finding the right person to call, especially in the outpatient setting.”

Effectively reporting critical imaging results requires constant vigilance. Even with an automated system, results reporting can’t run on autopilot.