The Joint Commission has emphasized the need for improved communication of critical test results as one of its 2010 National Patient Safety Goals. Delays in communication of critical results pose a significant threat to patient safety by creating delays in diagnosis, which eventually leads to delays in management. In diagnostic imaging, no standards currently exist for timeliness of communication of results, for ideal communication venues, and especially for deciding which results are critical. The Brigham and Women's Hospital Center for Evidence-Based Imaging established an enterprise-wide policy as part of a three-year quality improvement initiative to enhance communication of critical imaging results. The policy includes clear guidelines and procedures for notification of referring physicians whenever critical imaging results are identified. In a pilot study, the proportion of critical results fully adherent with this policy increased from 28.6% to 94.6% over three years. This pilot evaluation, however, required manual review of individual reports and therefore only reviewed 12,193 reports in three years (less than 1%). A full-scale evaluation would provide more definitive information regarding successful implementation and adoption of this policy The proposed project therefore plans the following specific aims: (1) Implement an enterprise-wide policy and intervention for enhancing communication of critical imaging results;(2) Evaluate this intervention by comparing its impact on appropriate alert notification for critical imaging results and documented critical results that were missed by the intervention;and (3) Develop an implementation toolkit for widespread dissemination. Implementation of the CCTR policy with full deployment of an Automated Notification of Critical Results system (ANCR) will commence at the project start date. In order to evaluate the deployment of enhanced critical imaging result notification (DECIRN), we will undertake a prospective single crossover clinical trial, comparing the intervention with baseline clinical practice. With over 600,000 imaging procedures performed at the BWH and its outpatient facilities annually, fully implementing this policy would greatly promote patient safety and encourage widespread adoption. Finally, an implementation toolkit will be disseminated, which includes a full resource guide to enable other institutions to adopt the CCTR policy and enable automated notification when possible.

Public Health Relevance

Delays in communication of critical results pose a significant threat to patient safety by creating delays in diagnosis, which eventually leads to delays in management. The Brigham and Women's Hospital (BWH) established the Communication of Critical Test Results (CCTR) policy to enhance communication of critical imaging results. This study aims to deploy an enhanced, automated implementation of this policy using Automated Notification of Critical Results, an automated critical imaging result management system to promote patient safety and encourage widespread adoption.

Agency
National Institute of Health (NIH)
Institute
Agency for Healthcare Research and Quality (AHRQ)
Type
Research Demonstration and Dissemination Projects (R18)
Project #
5R18HS019635-02
Application #
8144912
Study Section
Health Care Technology and Decision Science (HTDS)
Program Officer
Opstal, Marcy
Project Start
2010-09-30
Project End
2013-09-29
Budget Start
2011-09-30
Budget End
2013-09-29
Support Year
2
Fiscal Year
2011
Total Cost
Indirect Cost
Name
Brigham and Women's Hospital
Department
Type
DUNS #
030811269
City
Boston
State
MA
Country
United States
Zip Code
02115
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