RESEARCH & EDUCATION RETREAT
Title: Alert Notification of Critical Radiology Results (ANCR): Using IT Tools to
Enhance Monitoring and Management of Critical Results in Radiology
Authors: Luciano M. Prevedello, MD and Ramin Khorasani, MD, MPH
Timely communication of critical test results (CCTR) is fundamental to clinical practice
and patient safety. In the phase one of this project we investigated the impact of a 3-year
quality improvement initiative on the timeliness and effectiveness of communicating
critical and discrepant imaging results by performing a manual review of our reports. In
phase two, we built and implemented a computer application (ANCR) to facilitate
adoption of best practices in accordance to our policy on CCTR.
Materials and Methods: The departmental CCTR policy implemented in February 2006
(based on recommendations from the Joint Commission, the American College of
Radiology, and the Massachusetts Coalition for the Prevention of Medical Errors) defined
types of findings, urgency levels (red, orange, or yellow alert), notification timelines,
acceptable modes of communication, escalation process to assure timely communication,
and method of measuring adherence to policy. Adherence to CCTR policy was initially
measured during 17 quality assurance audits between February 2006 and May 2009. Each
audit included a day’s worth of report. In December 2009, the integrated version of
ANCR application was piloted in the abdominal section of the Radiology department of
Brigham and Women's Hospital (BWH). Using a commercially available business
analytics tool we were able to enhance our reporting and display capabilities with an
interactive view of the collected data.
Results: During the first phase of the project, 12,193 radiology reports were manually
reviewed and analyzed. 9.2% of all reports reviewed met CCTR policy criteria for
critical results. At BWH, adherence to CCTR policy rose from 28.6% in the first month
of policy implementation to 68% by the third month, reaching 90% by the 17th month (p
< 0.001). In the second phase of the project, 263 critical alerts were generated during the
first month of implementation. 4 (1.52%) alerts were red, 68 (26%) orange and 191
(72%) yellow. The application allows users to communicate critical findings through the
appropriate methods per our policy. In addition, it keeps track of every alert generated
assuring that they are acknowledged and the communication loop is closed. A “dashboard
view” of pending alerts is also available so they can be appropriately managed.
Conclusion: Development, implementation, monitoring, and reinforcement of CCTR
policy resulted in substantial improvement of departmental performance for CCTR.
Automation of CCTR reporting combined with enhanced analytical tools is helping us to
further improve patient safety and quality of care.