© 2011 American Society for Healthcare Risk Management of the American Hospital Association Published online in Wiley Online Library (wileyonlinelibrary.com) • DOI: 10.1002/jhrm.20057 AMERICAN SOCIETY FOR HEALTHCARE RISK MANAGEMENT • VOLUME 30, NUMBER 3 23 By Edward P. Monico, MD, Howard P. Forman, MD, T. Rob Goodman, MD, Ian Schwartz, MD, and G. Luke Larkin, MD Patient Safety A survey of policies and procedures on the communication and documentation of radiologic interpretations Research into emergency medicine (EM) diagnostic errors identified imaging as a contributing factor in 94% of cases. Discrepancies between the preliminary (trainee) and the final (attending) diag- nostic imaging interpretation represent a system issue that is par- ticularly prone to creating diagnostic errors. Understanding the types of systematic communication and documentation strategies developed by academic radiology departments to address differ- ences between preliminary and final radiology interpretations to clinicians are threshold steps toward minimizing this risk. This study investigates policies and practices associated with the communica- tion and documentation of preliminary and final radiologic inter- pretations among U.S. academic radiology departments through a questionnaire directed at radiology department chairs. INTRODUCTION Multiple interpretations of a single radiologic study arise out of education and staffing requirements or as a result of routine quality improvement endeavors. (1,2,3) In the past when differences arose, synchronous modes of communica- tion, such as face-to-face or telephone discussions, were sufficient to communi- cate the differences promptly to the appropriate party.(4) However, as radiology evolved, not all aspects of the specialty enjoyed the same rate of development. For example, the advent of teleradiology removed the responsible radiologist from the physical location of patients, clinicians, and the site of imaging.(5) Synchronous communication in the era of teleradiology has been found to demonstrate poor fidelity, with the original preliminary report details becom- ing “lost” in memory when superseded by the final version.(6) Moreover, syn- chronous communication by nature is fraught with interruptions that interfere with normal work flows.(7) Disruptions like this may actually impair cognitive processes and contribute to medical errors.(8) Harmonizing differences between preliminary and final radiology interpreta- tions has been identified as a system issue prone to error.(9) These errors have particular medicolegal ramifications for radiologists. Berlin reported in the continued on next page