A critical results notification system that combines software with a defined workflow for telephone communication can efficiently and reliably communicate critical results to referring clinicians, according to researchers from Cincinnati Children's Hospital Medical Center.
Thanks to internally developed software that manages a model featuring a liberal definition of a critical result, easy selection for crucial result notification methods, and the use of customer service representatives to telephone results, critical results are communicated by an average of a little more than 10 minutes after they are available, according to Dr. Alexander Towbin.
He presented the institution's experience with critical results notification during the recent Society for Imaging Informatics in Medicine (SIIM) 2013 annual meeting in Grapevine, TX.
Speed saves
The timely and accurate communication of critical results is an increasing area of focus, as highlighted in medicine as a whole in the Joint Commission's National Patient Safety Goals and in radiology in the American College of Radiology (ACR) Practice Guideline for Communication of Diagnostic Imaging Findings.
"There is a section in the introduction [of the ACR guidelines] that I think is very important, and it says that 'Quality patient care can only be achieved when study results are conveyed in a timely fashion to those responsible for treatment decisions,' " Towbin said.
Poor communication leads to poor patient care, sentinel events, and malpractice lawsuits, he said.
The ACR guideline delineates the components that make up good documentation of results notification. These include the time when results were communicated, method of communication, name of the person spoken to, and what is communicated. However, traditional methods of documentation have a number of problems, including consistency issues and not including the time of communication, Towbin said.
To improve on this situation, Cincinnati Children's developed their own critical results notification software.
(Disclosure: Cincinnati Children's later sold the software, a PACS plug-in called RadStream, to Amicas, which is now part of Merge Healthcare. The radiology department receives royalties from sales of the product and Towbin is a shareholder of Merge.)
System components
The institution's critical results notification system is based on three aspects: a liberal definition of a critical result, easy selection of studies to be communicated, and a reliable method to communicate results, Towbin said.
In contrast to other institutions that may have lists of results deemed to be critical, Cincinnati Children's defines a critical result as any result requiring immediate medical attention and communicated by phone, and any study in which the result is needed as soon as possible, he said.
The system also makes it easy to select studies to be communicated, according to Towbin. Studies can be selected for critical results communication at the time of imaging order by providers in either electronic or paper order forms, during imaging by technologists, and during image interpretation by radiologists by pressing a button in the PACS software.
Instead of relying on radiologists to communicate the results, the institution utilizes customer service representatives, who telephone all critical results to the ordering provider and document the communication. All studies that have been selected for critical results communication are placed in the software's real-time work queue, which is used by the representatives to select a study and begin the process of communicating to the clinician.
"In our system, they are able to see the result, read the result to the clinician, and document every step," he said. A date and time stamp is automatically included, not just for actual communication but for every communication attempt.
Speedy communication
Researchers at Cincinnati Children's evaluated the number of results communicated via the system in 2011 and evaluated the mean time to communicate results. They also sought to determine if their liberal definition of critical results captured five commonly listed critical findings: torsion, tension pneumothorax, pneumoperitoneum, infarct, and embolus.
In 2011, the institution performed 218,980 studies. From these, 25,767 (11.8%) were communicated by phone using the critical result notification system.
Of the 210 reports with the five specific critical findings, 201 (95.7%) were communicated using the system. The mean time to communicate a critical result was 10.8 minutes, with approximately 53% communicated in less than 10 minutes, Towbin said. About 75% of all reports were communicated within 20 minutes.
"Our results are also showing that our customer service representatives are able to do this very quickly and efficiently, compared to what often happened with radiologists in practice," Towbin said.
The institution's approach to critical results notification has yielded a number of benefits at the institution, including an efficient method and a liberal, common-sense definition of a critical result, Towbin said. In addition, it enables multiple methods at various steps of the process to identify a critical result and also improved documentation.
