Communicate with the Patient on Surveillance Imaging Findings

CHICAGO - Communicating urgent findings are critical to patient safety, but it’s those not-so-urgent findings that don’t always make it to the right physician at the right time for effective follow up.

That’s what Paul Chang, MD, radiology professor and vice chair of radiology informatics at the University of Chicago Medical Center, was finding in his department. Radiologists were doing a pretty good job getting the urgent results to the referring physician through a phone call or in the report.

“We do OK on life threatening emergent results,” he said, speaking on a panel at RSNA Tuesday. But those less immediate surveillance findings, like a lung nodule, that may need physician follow up in several months rather than in a few seconds or minutes can slip through the cracks or be easily ignored.

For those results, that phone call interrupting the referring physician wasn’t appropriate. In fact, Chang found that different results required different modes of communication. He took a note from his kids who use several different methods, from Twitter to Skype to Facebook to text messaging, depending on the message and to whom it was being delivered. Radiologists should do the same depending on the level of urgency of the finding and look beyond the phone call and the report. “One size doesn’t fit all,” he said.

Chang developed a priority matrix, matching the appropriate method of communication to the clinical context. Life threatening, emergent results warrant a phone call. For emergent findings, where it’s not seconds, but perhaps hours, a radiologist could replace that phone call with a system that triggers an alarm in the ER or ICU, alerting of the finding. The alarm doesn’t stop until someone acknowledges the results, Chang said, referring to a system built into the PACS that his department uses and has proven even more effective than a phone call.

But what about that important, yet not time sensitive finding? That’s similar to the knowledge that in April you’ll have to file your income taxes, Chang said. Imagine paging or calling a physician with that knowledge. “What will I do with that?” he asked, adding it’s not appropriate to interrupt a physician immediately with that long-term knowledge. But give them an electronic alarm notification and it will go ignored.

Solving this level of communication proved to be the most difficult, Chang said. Even building a database that flagged physicians for follow up wasn’t effective.

The solution? Communicate with the patient. This happens with breast imaging patients, so why not others? Patients will tend to follow up on their own healthcare.

“Patients don’t blow off these messages,” he said, adding his department has just started this process. “We have suspended all this fancy software, and instead we get a certified letter to patient,” suggesting they communicate with their ordering physician about a result they found on the imaging scan.