Christopher Trimble MD, MBA, Presenter: Nothing to Disclose

William W. Olmsted MD, Abstract Co-Author: Nothing to Disclose

Shahine Baghai MD, Abstract Co-Author: Nothing to Disclose

Amy Kunce ARRT, Abstract Co-Author: Nothing to Disclose

Eliot L. Siegel MD, Abstract Co-Author: Research Grant, General Electric Company Speakers Bureau, Siemens AG Board of Directors, Carestream Health, Inc Research Grant, XYBIX Systems, Inc Research Grant, Steelcase, Inc Research Grant, Anthro Corp Research Grant, RedRick Technologies Inc Research Grant, Evolved Technologies Corporation Research Grant, Barco nv Research Grant, Intel Corporation Research Grant, Dell Inc Research Grant, Herman Miller, Inc Research Grant, Virtual Radiology Research Grant, Anatomical Travelogue, Inc Medical Advisory Board, Fovia, Inc Medical Advisory Board, Toshiba Corporation Medical Advisory Board, McKesson Corporation Medical Advisory Board, Carestream Health, Inc Medical Advisory Board, Bayer AG Research, TeraRecon, Inc Medical Advisory Board, Bracco Group Researcher, Bracco Group Medical Advisory Board, Merge Healthcare Incorporated Medical Advisory Board, Microsoft Corporation Researcher, Microsoft Corporation

Most radiology practices have a standardized pathway to report critical and important (need for imaging follow up) findings based on ACR guidelines. Initiating this pathway employs a dual system of personal notification of the referring physician and documentation of notification in the report. The purpose of this study was to determine the frequency of recording of referring physician notification in the radiology report and its implications.

954 consecutive CR, CT, and US studies from a 2012 radiology report database were manually reviewed to determine identification and referring physician notification of critical and important findings in the report. Criteria were based on ACR and institutional guidelines. Categories recorded were: identification of findings (I) and record of physician notification (N) in body or conclusion of the report (I/N), identification of critical findings (C) but no notification (I-C only), and identification of follow-up study needed (F) but no notification (I-F only).

154/954 (16.1%) of reports were noted to contain critical/important findings. 33/154 (21.4%) were categorized as I/N, 64/154 (41.6%) as I-C only, and 57/154 (37.0%) as I-F only.

While 16% of reports in this representative report database contained mention of critical/important findings, only approximately 21% were properly placed into the critical findings pathway with notification of the referring physician mentioned in the report. In the remaining reports, while findings were properly recorded, there was no mention of notification of the referring physician/activation of the pathway. Thus, these patients may be lost to follow up. Reasons for notification failure include lack of knowledge of expected procedure, lapse in following procedure guidelines, or disorganized reporting techniques. Additional education about the system pathway and expectations may be key to a culture change. Structured reporting with electronic notification of referring physicians would provide a reminder and improvement for interpreting radiologists, resulting in better patient care.

This study is of interest to all radiologists seeking to improve communication with referring clinicians regarding the critical findings algorithm. Occasional report auditing may identify areas for improvement in implementation of clinical findings pathways.

Trimble, C, Olmsted, W, Baghai, S, Kunce, A, Siegel, E, Initiating the Critical Findings Pathway: The Need for Inclusive Radiology Reporting.  Radiological Society of North America 2014 Scientific Assembly and Annual Meeting, - ,Chicago IL. http://archive.rsna.org/2014/14045672.html