Audit of Radiology Alert system for critical urgent

Audit of Radiology Alert system for critical, urgent and unexpected significant findings K A Duncan K Drinkwater On behalf of CRAC May 2015

Background

Timeline • 2007 NPSA Safer practice notice 16. Early identification of failure to act on radiological imaging reports • 2008 RCR Standards for the communication of critical, urgent and unexpected significant radiological findings • 2012 RCR Standards for the communication of critical, urgent and unexpected significant radiological findings Second edition

Stated Standards • It is the responsibility of the radiologist to produce reports as quickly and efficiently as possible. • It is the responsibility of the requesting doctor and/or their clinical team to read, and act upon, the report findings as quickly and efficiently as possible. • It is the responsibility of the trust, or other equivalent healthcare organisation, to provide systems, whereby as soon as a verified imaging report has been produced, it is easily available to be read and acted upon by the referrer, their team, and other relevant clinicians.

2010

Method • Survey Monkey link sent to all Clinical Radiology Audit leads Followed up by reminder emails • 19 questions regarding current departmental policy, automated electronic alert system, practicality of notification of clinicians and monitoring, types of pathology included.

Results • 154 responses of which 150 were complete 67% response rate

Respondents

Do you have a defined policy on the communication of critical, urgent and unexpected significant findings? 136 17

Is this a Trust policy which has been agreed with your referring clinicians?

Do you have automated electronic alert system to all referring clinicians? 34 101 18

How was this actioned / financed?

Is the electronic alert system part of PACS/VRS/RIS? 31 21

Integrated electronic alert system to all referrers 11 10 9 8 7 6 5 4 3 2 1 0 nt Ra di a t I-S of So lit on ra Se ct re am st re Ca en t dc Ra CR IS re Sectra Centricity GE Phillips Carestream Insignia Agfa

Integrated electronic alert system to hospital clinicians 6 5 Sectra Centricity GE Phillips Carestream Insignia Agfa 4 3 2 1 0 CRIS Radcentre Sunquest Phillips Cerner Bespoke

What type of electronic result acknowledgement system do you have?

If you have acknowledgement system to indicate report read, which reports is this used for? 11 15

Who monitors that the clinicians have read (and actioned) reports? 3 5

How do you notify hospital clinicians (tick all that apply) Only 3 hospitals rely on their electronic system – all others using additional feedback mechanism also.

How do you notify GPs? (tick all that apply) Only 2 hospitals rely on their electronic system – all others using additional feedback mechanism also.

How do you deal with outsourced reports with critical, urgent or unexpected findings?

Do you send patients a standard letter if an examination is abnormal?

For new cancer findings, do you issue alerts? 121 3 17

For critical findings, do you issue alerts?

For urgent/significant/unexpected findings do you issue alerts?

For Emergency Department reports, do you use a red dot or commenting system?

If fracture not picked up by radiographer, do you notify Emergency Department staff?

Conclusion • Wide variation in practice • Many departments not compliant with RCR 2012 guidelines

Action Plan • Distribute results to all Audits Leads and Clinical Directors • Increase awareness of what we need PACS/RIS suppliers to provide • Consider follow up audit?

Acknowledgments • All the Clinical Audit leads and Clinical Directors who responded • CRAC members for their advice