H. Benjamin Harvey MD, JD, Presenter: Nothing to Disclose

Tarik K. Alkasab MD, PhD, Abstract Co-Author: Nothing to Disclose

Gloria Maria Martinez Salazar MD, Abstract Co-Author: Nothing to Disclose

Daniel Ira Rosenthal MD, Abstract Co-Author: Nothing to Disclose

G. Scott Gazelle MD, PhD, Abstract Co-Author: Consultant, General Electric Company Consultant, Marval Biosciences Inc

Failure to appropriately communicate the results of radiologic examinations in urgent or non-routine clinical situations is a common source of medical malpractice liability in radiology. In 2009, the Departments of Radiology across our large integrated health system came together and developed guidelines for non-routine communication of diagnostic imaging findings based on the urgency of the findings and in view of existing guidelines and requirements.  We study radiologist compliance with the guidelines nearly three years after implementation.

From July 2012 through March 2013, 6,716 randomly selected radiology reports with images across all sections were reviewed in a peer-review conference format by at least three radiologists. The reviewing radiologists were asked to reach a consensus on two questions relating to non-routine communication: (1) “Does the report describe a finding which requires non-routine communication to the patient’s physicians?” and (2) if so, “'Were departmental guidelines for non-routine communication followed?” Consensus judgments were subsequently aggregated and analyzed based on section, level of acuity per the guidelines (i.e. Level 1, 2 or 3), and type of communication employed.

Of the 6,716 studies reviewed, 718 (10.7%) were deemed to require non-routine communication of results and 17 (0.3%) resulted in no consensus as to whether non-routine communication was required. Out of the 718 studies deemed to require non-routine communication, 20 cases (3%) resulted in a consensus that the guidelines were not followed: 4 of these were level 1 findings, 4 were level 2 findings, and 12 were level 3 findings. Neurological imaging accounted for the majority of the failures of non-routine communication with 60% of the cases and all of the cases involving level 1 findings (e.g. new ventricular entrapment, new subarachnoid hemorrhage, and new acute cortical infarction). Cases in which no consensus could be reached primarily involved Level 3 findings.

Guidelines for non-routine communication are appropriately applied in the vast majority of clinical cases at our large academic medical institution years out from their introduction.

Non-routine communication of radiologic results is an important aspect of the radiology quality and safety landscape and efforts to ensure that it occurs consistently and effectively remain essential.

Harvey, H, Alkasab, T, Salazar, G, Rosenthal, D, Gazelle, G, Radiologist Compliance with Institutional Guidelines for Use of Non-routine Communication of the Results of Radiologic Examinations.  Radiological Society of North America 2013 Scientific Assembly and Annual Meeting, December 1 - December 6, 2013 ,Chicago IL. http://archive.rsna.org/2013/13017823.html