The Joint Commission has emphasized the need for improved communication of critical test results as a National Patient Safety Goal (NPSG). This goal includes subsequent implementation of follow-up procedures for managing critical test results. 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. This was facilitated by a notification system, partly funded by AHRQ, which enables alert notification of referring providers when results from imaging exams are deemed critical by a radiologist at the time of interpretation. Although there has been increase in documented communication of critical results between caregivers, there exists a deficit in adherence to recommended follow-up testing. There is especially no mechanism to monitor and ensure follow-up of patients who have critical imaging results that need to be followed across transitions in patient care settings. Some critical results are not emergent, but are nevertheless critical and actionable. These have been referred to as actionable test results and comprise a vast majority of all critical imaging results. We therefore plan to design and evaluate an automated notification system, which (1) recognizes critical imaging results that require follow-up testing for inpatient and ED patients when transitioning to ambulatory care, and (2) populate the discharge summary with these follow-up testing recommendations. This would enable communication and documentation of follow-up testing recommendations, and assess whether these recommendations are performed in a timely manner. The proposed project therefore plans the following specific aims: (1) Implement an automated notification system for (a) monitoring critical imaging results that require follow-up testing and (b) documenting them in the discharge summary;and (2) Evaluate this automated system by assessing its impact on scheduling or completion of recommended follow-up procedures for two critical imaging findings - pulmonary nodules and renal mass. The project will focus on patients that had these critical imaging findings discovered in inpatient and emergency department (ED) settings. Subsequent follow-up testing recommendations are expected to be completed in an ambulatory setting. Implementing a system that monitors follow-up recommendations of critical imaging results and automatically documenting them in the discharge summary will be completed during the first half of Year 1. In order to evaluate the notification system, a comparison will be conducted with baseline clinical practice. With over 500,000 imaging procedures performed at the BWH and its outpatient facilities annually, fully implementing this intervention would greatly promote patient safety by ensuring that follow-up testing of critical imaging results are communicated to primary caregivers in the ambulatory setting through the hospital discharge module, and documented in the discharge summary of patients who transitions from ED or inpatient settings to ambulatory care. In addition, a successful evaluation and demonstration of the overall system will provide an impetus for other integrated health systems to implement a similar approach that will enable enhanced communication and performance of follow-up management, not solely for critical imaging results but for all critical test results.

Public Health Relevance

Delays in implementation of follow-up testing for critical results pose a significant threat to patient safety. This study aims to deploy an automated notification system to promote adherence with evidence-based recommendations for further testing by monitoring critical results requiring follow-up and including these recommendations in the discharge summary module.

Agency
National Institute of Health (NIH)
Type
Exploratory/Developmental Grants (R21)
Project #
1R21HS022586-01A1
Application #
8772547
Study Section
Health Care Technology and Decision Science (HTDS)
Program Officer
Lomotan, Edwin A
Project Start
Project End
Budget Start
Budget End
Support Year
1
Fiscal Year
2014
Total Cost
Indirect Cost
Name
Brigham and Women's Hospital
Department
Type
DUNS #
City
Boston
State
MA
Country
United States
Zip Code
02115