Training all residents, fellows and faculty radiologists on a critical notification protocol, along with providing better access to the department’s policies on this procedure, will decrease the time it takes to perform critical notification (defined as critical notification time (CNT)) and ensure that all critical notifications are documented on the first line of the dictation’s impression (defined as first line dictation (FLD)) for the those patients.

Failures and delays in the communication of critical test results across multiple departments is an all too often pinnacle of inefficient health care delivery. An increasing onus is being placed on radiologists to ensure critical test results are communicated to the referring clinicians, particularly when an urgent or unexpected diagnosis is made (Page, 2007). The Joint Commission on the Accreditation of Healthcare Organizations (JCAHO), in its efforts to ensure patient safety, requires that critical diagnostic tests and their results be defined by the healthcare organization (HCO), and requires a notification process for critical results be put in place, together with timeliness of reporting (JCAHO, 2006). To adhere to these standards and to be in compliance, radiologists must have extensive knowledge and comprehension about the critical results protocols and play a role in establishing these protocols for the HCO. Failure to define and adhere to the established protocols can lead to a lack of timely action on critical results and jeopardize patient safety and the HCO's JCAHO accreditation.

During a monthly QA conference, a dedicated lecture detailed the JCAHO standard for critical results notification (CRN). The critical tests defined by our institution were enumerated (e.g., pulmonary embolism, etc.). Our initial notification standard, of a one hour turnaround from viewing the image to contacting the ordering physician with the result, was affirmed. Effective communications were stressed, including the "read back" requirement to confirm receipt of the critical result, then repeating back the finding and the patient to whom the finding refers. Standardized reporting of the communication required that CRN be documented in the first line of the report's impression. A before-and-after protocol was used to measure whether or not the interventions had a positive effect. The communication metrics study included critical notification time (CNT) and first line dictation (FLD), along with compliance percentage.

Metrics collected for the study included: total number of critical results and the percentage of critical results in compliance with initial notification standard (i.e., < 1 hour from viewing the exam, with a consistent documentation process). A total of 454 critical results were reported between 02/01/07 and 12/31/07. The CNT percentage compliance varied from 90.32% to 94.51% between the two time periods. There was a statistically significant percentage increase for FLD from 61.75% to 83.97%. The process resulted in defining and expanding on a critical notification results list for the HCO.

JCAHO requires that all testing and diagnostic areas within HCOs establish a standard list of critical test results (Revere, 2007). An advantage of studying the outcomes of the critical notification data included broadening the pre-defined critical notification results list. Analyzing this data allows department administration and physician staff to develop a list of critical results that require urgent notification. Our findings affirm the need for high reliability in communicating critical results in the hope of achieving high-quality health care. The noted training intervention incorporates JCAHO safety goals of improving teamwork and communication among caregivers (Revere 2007), by encompassing all personnel who are directly involved in interpreting the radiologic findings and relaying the critical results. Integrating proven safety and performance improvement interventions, such as training, helps to simplify the standards and procedures associated with critical results notification.

The use of training interventions (QA meeting training sessions) and external representations (desktop reference of critical notification procedures on radiology PCs) can help in fostering retention of standard procedures with integration of these interventions in the daily critical results notification workflow. Our findings indicated a positive influence on the standardization of communicating critical results. By implementing an intervention, such as reiterative training, first line dictations rates increased due to the system change and the department’s policies became better aligned with physician practices (in terms of defining critical test results).

Page, D. “Errors continue to plague communication of abnormal imaging results,” PACS web - News Updates. 2007. Available at: http://www.dimag.com/pacsweb/newsupdate/showArticle.jhtml?articleID=201201643. Accessed November 20, 2007

Revere, A. “JCAHO National Patient Safety Goals for 2007” TIPS (Topics in Patient Safety). 2007; Vol. 7, Issue 1.

Joint Commission on Accreditation of Healthcare Organizations. “Sentinel event statistics, March 31, 2006.” Joint Commission on Accreditation of Healthcare Organizations, 2005.