Communicating Critical Results in Radiology Sarwat Hussain, MD DESCRIPTION OF THE PROBLEM Compliance with the communica- tion of critical diagnoses is man- dated by the Joint Commission’s National Patient Safety Goal 2 (NPSG-2), “Improve the Effective- ness of Communication Among Caregivers,” which addresses the communication of critical labora- tory and radiologic findings to re- ferring providers. The salient fea- tures of compliance with NPSG-2 are timely and direct communica- tion with referring providers, or the maintenance of a verifiable record of communication, and timely es- calation of fail-safe processes when referring providers are not immedi- ately available [1]. There are pres- ently two methods to achieve compli- ance when communicating critical diagnoses in radiology: manual in- house and commercial automated approaches. The former is labor in- tensive and fraught with trial and error. The latter is software driven, was costly, and had poor acceptance due to real or perceived inability to discuss critical results with radiolo- gists and clinicians’ dismay at being disturbed after hours for diagnoses they do not consider critical. The full implementation of critical communication requires buy-in by radiologists as well as hospital ad- ministration and the referring phy- sicians on the medical staff. Na- tionwide, to date, the introduction of policies for critical communica- tion in radiology departments has met with only varied success. In an imaging performance partnership survey of 92 departments, only 31% achieved compliance with a critical results communication rate of 90% [2]. According to a Joint Commis- sion survey of 51 departments on critical results communication policy development and implementation, 42% were compliant, 58% were not, 24% had not developed policies, and the policies of 34% were not consis- tent with Joint Commission require- ments [3]. After evaluation of both manual and automated approaches, my institution, University of Massa- chusetts Memorial Health Care, elected to use a manual, in-house, self-developed solution. In this com- munication, I describe our experi- ence and offer suggestions for its use in similar environments. HOW WE ADDRESSED THE PROBLEM We began by writing the departmen- tal critical communication policy to precisely reflect NPSG-2 and having it approved by the hospital leader- ship. The important features of this policy were clarity of objectives and expectations, definitions of terms, and the delineation of a time line. Policy appendices included a list of critical tests and critical results, as well as the time line of communication. We adopted the recommendations of the Massachusetts Coalition for the Prevention of Medical Errors: emer- gent (red alert), which indicates that communication must occur within 1 hour (in practice, such communica- tion is immediate and interruptive), urgent (orange alert), which indicates that communication can occur within 8 hours, and nonurgent (yel- low alert), which indicates that com- munication can wait up to 24 hours (Table 1) [4,5]. It is noteworthy that there is neither any specific Joint Commission mandate nor any na- tional consensus on the list of critical Table 1. Critical results calling policy Level of Urgency Critical Results Emergent: call result within 1 hour: red alert Airway compromise, any cause New, significant, or tension pneumothorax Unexpected free air in the abdomen Intracranial bleed Acute spinal cord compression Leaking/ruptures/dissected aneurysm Significantly misplaced lines or tubes Bowel obstruction (volvulus, etc) Pulmonary embolism Ectopic pregnancy Urgent: call within 8 hours: orange alert Suspected child abuse Unexpected mass/malignant tumor Hydrocephalus grade III (neonate) unsuspected Possible/probable active tuberculosis Shunt malposition Nonurgent: call within 24 hours: yellow alert Lung nodule on preoperative chest radiograph Solid renal mass THE VOICE OF EXPERIENCE © 2010 Published by Elsevier Inc. on behalf of American College of Radiology 0091-2182/10/$36.00 ● DOI 10.1016/j.jacr.2009.10.012 148