Implementing a Critical Results Call-Back System

In today’s fast-paced medical environment, there are more demands imposed on clinicians to deliver quick and accurate care. This has made it difficult for them to review imaging results in a timely fashion, resulting in potential dire consequences for their patients and medical-legal complications. 

The expectations on radiologists have also escalated as non-invasive imaging study volume has exploded, with increasing reliance on diagnostic radiology in-patient care. Therefore, timely communication between radiologists and clinicians has become increasingly critical in today’s medical delivery system.

Our institution has recently successfully implemented a call-back system to convey unexpected and critical results, allowing more timely result delivery to the busy clinicians, thus expediting patient care.

The critical test result management solution - we use Nuance’s Veriphy - was implemented across the enterprise at our busy 700-plus-bed community hospital, with more than 1,000 admitting physicians and satellite clinics in the heart of Brooklyn, NY.

The technology is quite simple yet very effective. We started by introducing the technology and the possibility of deploying this tool at various high level meetings throughout the enterprise. Once it gained acceptance at the administrative level, a questionnaire was developed and sent to all staff members with their preferred method of being contacted. We did have to elicit the assistance of the chairman to insure that everyone responded.

Based on that information, the database was built. The radiologists defined the criteria for what is considered a critical result (perforation, aortic dissection, acute pulmonary embolus, pneumothorax, etc.), and what is unexpected (pulmonary nodule, etc., or anything that was not expected on a imaging study that would require further work-up).

When the radiologist encounters an unexpected or critical finding, they log into the system, insert the patient’s name, medical record number and attending physician and then record a brief audio file with the salient findings. Results can be sent to more than one physician.

The attending physician will be contacted via their preferred method of contact as they specified in the aforementioned questionnaire. When contacted they are given a unique pin number to put into the system when they call in to listen to the message. Once they hear the message it is stamped as received and stored in a database. Doctors have 30 minutes to reply to a critical result and 24 hours to an unexpected finding. If they fall out of compliance, there is an escalation process to a designated radiology administrator who is available 24/7 and who will pursue the physician. Physician compliance is monitored at monthly quality assurance meetings and reported to the appropriate chairperson.

There has been a tremendous positive impact on radiologist’s daily workflow. This call-back system has allowed us to deliver important information to the referring physician quickly and efficiently. The radiologists can devote their efforts to image interpretation and waste very little time on the phone trying to find the physician of record. What is best about this technology is that important information never falls through the cracks of manual type systems we used in the past.
Despite early resistance from a few clinicians stemming from concern of workflow disturbance, there is now widespread acceptance of this technology, with increasing clinician satisfaction and radiologist productivity.

The process of reaching clinicians “live” in today’s hospital environment without leveraging assistive technology is time-consuming and ineffective, to say the least. Radiologists should not be relying on indirect communication via fax and administrative staff. The technology is out there and waiting to be leveraged so why not make the first step and start exploring your options?

Mark Flyer, MD, is vice chair of radiology at Maimonides Medical Center in New York.