Radiology Critical Diagnostic Imaging Findings

Susan Shepard, MSN, RN, Senior Director, Patient Safety and Risk Management Education, and Cynthia Morrison, RN, CPHRM, Senior Patient Safety Risk Manager.

Expediting critical/nonroutine results by implementing an effective communication process will reduce the likelihood of missed results that can lead to patient harm and, ultimately, to a liability claim.

Have processes in place that expedite the delivery of diagnostic imaging reports and ensure that the respective department or physician (such as surgery, hospitalist, or the emergency department physician) receives findings promptly. Include discrepant findings from any preceding interpretations.

Assist your peers as part of the process by ensuring there is a reciprocal duty of information exchange. The referring physician or other relevant healthcare provider shares responsibility for obtaining the results of imaging studies that he or she has ordered. The request for imaging should include relevant clinical information, a working diagnosis, and/or pertinent clinical signs and symptoms. The request should also include a specific question to be answered. Communicate to your peers what you need in order to facilitate an accurate diagnosis.

Consider the following strategies for nonroutine communications:

  • Develop policies that define:
    • Which findings suggest a need for immediate or urgent intervention.
    • When immediate communication is required on discrepancies between preliminary reports and final reports in which a failure to act may adversely affect patient health.
  • Communicate directly when there are unexpected findings that may seriously affect the patient’s health.
  • Document all nonroutine communications, and include the time, method of communication, and the name of the person receiving the communication.
  • Use a communication system that is most likely to reach the attention of the treating or referring physician in time to provide the most benefit to the patient.

Implement best practices, and monitor them as an ongoing quality improvement process. Consider these recommendations:

  • Identify the ordering provider who should receive the results, and ensure your contact information is correct.
  • Identify the individual to receive the results if the ordering provider is not available.
  • Define which imaging results require immediate and reliable communication.
  • Identify when imaging results should be actively reported to the ordering provider, and establish explicit time frames for this purpose.
  • Identify how to notify the responsible provider(s) (i.e., what communication system works best).
  • Establish a shared policy for uniform communication of all types of test results (laboratory, radiology, cardiology, pathology, etc.) to all recipients.
  • Partner with patients in the communication of results.

For more information, see the Initiatives section of the Massachusetts Coalition for the Prevention of Medical Errors and the ACR Practice Parameters for Communication of Diagnostic Imaging Findings.

The guidelines suggested here are not rules, do not constitute legal advice, and do not ensure a successful outcome. The ultimate decision regarding the appropriateness of any treatment must be made by each healthcare provider considering the circumstances of the individual situation and in accordance with the laws of the jurisdiction in which the care is rendered.

J10637 08/16


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