A U.K. audit has found that patients are being put at risk, because in only 11 out of 26 radiology departments with an electronic acknowledgement system are staff regularly monitoring the read rate to ensure that critical findings are acted upon.
The research, organized by the Royal College of Radiologists (RCR), involved sending out a questionnaire to all U.K. radiology department audit leads. A total of 154 out of 229 responded. Led by Dr. Karen Duncan from the radiology department at Aberdeen Royal Infirmary, the authors found a wide variation in practice across the U.K. with regard to the communication and monitoring of reports, and many departments are not fully compliant with published U.K. guidance.
"We are increasingly using technology to communicate imaging reports, but many hospitals do not yet have in place reliable alert systems," she noted in a statement. "As workloads and pressures increase, it is essential that safe and reliable processes are in place."
How this arose
After receiving a number of reports of patient harm due to failed communication in 2007, the National Patient Safety Agency (NPSA) published safer practice notice 16: Early identification of failure to act on radiological imaging reports. This was followed by the RCR's publication of "Standards for the communication of critical, urgent, and unexpected significant radiological findings," first published in 2008 and revised in 2012.
The guidance states the radiologist is responsible for producing reports as quickly and efficiently as possible, and requesting doctors and/or their clinical team are responsible for reading and acting upon the report findings as quickly as possible. But how compliant are U.K. departments?
To find out, Duncan and colleagues asked for details of the departments' current policy regarding the issuing of alerts; use of automated electronic alert systems; methods of notification of clinicians of critical, urgent, and unexpected significant radiological findings; monitoring of results receipt; and examples of the more common types of serious pathologies for which alerts were issued (Clinical Radiology, 28 December 2015).
In January 2015, all U.K. radiology department audit leads listed on the RCR audit lead database were invited by email to participate in the audit. The email included a Web-accessed electronic questionnaire comprising 19 questions. Follow-up emails were sent to audit leads and clinical directors in February. Data collection ceased in April 2015.
Results
About two-thirds (154) radiology departments responded. The researchers found 88% had a policy in place for communicating critical, urgent, and unexpected significant radiological findings. Only 34% (53) had an automated electronic alert system in place, and only 17% had a facility for service-wide electronic tracking of radiology reports. In only 11 of 26 departments with an electronic acknowledgement system, was someone regularly monitoring the read rate.
Other findings included the following:
- In 31 departments, the electronic alert system formed part of the RIS/PACS/voice recognition system.
- In 21 departments, it served as an additional bolt-on system.
- There were seven different PACS and eight RIS systems with 20 different combinations.
- The medical director was responsible for monitoring the read rate in two departments; the radiology clinical director was responsible in three departments; the directorate manager in two; and one of each of the following: the radiology superintendent, the IT department, the audit department, and the hospital safety department.
- In 15 departments, the result acknowledgement system was not being used although it was available.
- Most departments had a range of safety-net procedures in place, such as contacting referrers by telephone, e-mail, and fax, and also notifying the relevant multidisciplinary team coordinators, as advised by the NPSA report.
- 71% of the responding departments used outsourcing; however, many departments using outsourcing had no fail-safe method for passing alerts raised by the outsourced reporter to referring clinicians.
- Emergency department red-dot systems provide a further type of alert, bringing the referrer's attention to abnormalities picked up by the radiographic staff carrying out imaging: 125 of responding radiology departments used a red-dot system with 88 (71%) of these routinely notifying emergency department staff if a fracture had been missed by the radiographer, and a further 33 (26%) notifying them sometimes.
"Neither the NPSA nor the RCR guidance indicates what constitutes critical, urgent, and unexpected significant findings, and, therefore, not surprisingly, what is included in local hospital policies is very variable," the study authors noted.
Also, an electronic system in itself does not fulfill the guidance unless the radiologist is confident the system is being used reliably by the referrer and that there is no danger of the unexpected significant findings not being seen by the referrer, they added.
Commenting on the findings, RCR President Dr. Giles Maskell said, "Tragically, we continue to hear of cases in which results go astray and patients come to harm through delayed diagnosis or incorrect management. We urge all trusts, health boards, and other providers of imaging services to review their processes and ensure that the systems for communication of important test results are robust."
