FINDINGS DELIVERY LITERATURE REVIEW

undesirabletwitterAI and Robotics

Oct 25, 2013 (3 years and 9 months ago)

57 views

FINDINGS DELIVERY
LITERATURE REVIEW

ACR guidelines:

Preliminary Report: writting, electronically, or verbally. Must be documented

Non
-
routine communications are needed for:



those that need immediate or urgent intervention (ie pneumothorax).



Unexpected
findings that may adversely affect patient health.



Findings discrepant from previous report/prelim that may adversely affect patient care.


Documentation of non
-
routine findings communication



Name of the person receiving the result.



Provide discoverable do
cumentation.


Methods of communication:



Those most likely to reach the physician in time

to provide most benefit to the patient.

o

Telephone to physician or when judged appropriate, to interpreting physicians designee.



Challenge of alternative forms of comm
unication (text page, sms, email, etc) is receipt of message.



“Informal” ie curbside consults: risky because there is usually no record of these. Radiologists
encouraged to document them whenever possible.


-

encourage communication


Choksi et al. 2004 AJR

Semiautomated Coding and Review

for Notification of Critical Findings:



Report tagging with “fake” codes to flag for monitoring suggested followup of critical results for cancer
patients.



Lakhani

et al 2010 JDI Automated Detection of Radiology Reports Document Non
-
routine Communication



Natural language processing algorithm report text to identify documentation of critical results. Found
97% “precise” compared to human review methods in database of

2.3 million reports.



Towbin et al. 2011 AJR Cincinnati Children's Comprehensive Customer Service and Critical Results
Management



FYI
-

Root cause of 70% Sentinel events is poor communication.70
-
80% malpractice law suites
attributed to failure to communi
cate causative factor, despite the fact that the radiology report was
timely in 75% of cases. Often radiologist contacted or tried to contact referring physician, but this
communication was not documented.



Software to serve as link between radiologists, cl
inicians, & “customer service reps”



Communication could be initiated at either end (referring clinicians for consults or radiologist for critical
results communication) via the customer service reps through the software.



2 options for radiologist: initiate

and carry out the communication presonaly (system serves as a
directory/document tool) or create a flag for assistant to communicate and document findings.



Worklist style “to do list” for assistants to follow up on with referring physicians throughout the

day.



System was used in 14% of studies dictated.



100% communication of desired results.



Phone calls now triaged by non
-
radiologists, improving workflow.



Single number to contact the radiology department (rather than the each reading room approach).



Assist
ants need skill sets of customer service, rather than specific medical training.



ROI/Cost effectiveness was not analyzed.



Still difficult to document face to face curbside consults.



Partners System

Anthony 2011 Radiology Impact of 4
-
year quality improvem
ent imitative to improve communication of critical
imaging test results

Eisenberg et al. 2010 Radiology Electronic Messaging System for Communicated Abnormal Imaging Results



Adherence to policy increased from 29% to 90%.



Berlin 2010 Applied Radiology Fai
lure of Radiologic Communication: An increasing cause of malpractice
litigation.

Berlin 2002 AJR Malpractice Issues in Radiology.pdf



Case review for litigation related to results reporting issues.



Conclusion: Legal precedent established now that the
communicating of results just as much the duty
of radiologist as it is the rending of interpretations.



Courts also expanding role of radiologists to report results directly to patients of referring clinician
cannot be found.



Radiologists should familiarize

themselves and abide by the ACR’s guidelines.



Baker 2010 Radiology Transmission of Non
-
emergent Critical Findings: Communication versus Consultation



Disproportionate number of errors ocurring after 3pm and on weekends.



Argues against midlevel assistent
facilitators of communication of non
-
emergent critical results,
favoring instead a radiologist
-
initiated direct communication with the referring/treating physician.



Requires keeping a separate directory of providers and referring physicians. Bilateral agre
ements with
clinical services to create a roster of deisgnees to promptly consult with when physician of record is not
available.



Gale 2011 JACR Failure to Notify Reportable Test Results
-

Significance in Medical Malpractice



Joint Commission National Pat
ient Safety Goal 2 = communication of reportable findings.



Review of malpractice litigation across all specialties naming (1) communication problems between
practitioners (2) failure to instruct of communicate with a patient or family and (3) failure to re
port on
patient condition.



Went from 21 million in payouts in 1991 to 91 million in 2010.



Radiology 5th most common primary service named and most common secondary responsible party
named in suits.



1) Patients did not receive results
-

no report or wrong r
eport 2) clinicians did not receive reports 3)
Failure or delay in reporting findings or revised findings 4) Turnaround time too long 5) Results were
filed before clinician had a chance to review them 6) Report went to wrong clinician.