Communication of critical radiology results is an exercise in frustration for radiologists and referring physicians--and can be deadly for patients.

At Brigham and Women's Hospital in Boston, a Web-based critical results reporting system has eliminated the seemingly endless loop of pages, phone calls and faxes that often occur when radiologists are trying to get information into the right hands in time to make a clinical impact.

Ramin Khorasani, M.D., vice chairman of radiology at BWH, said during RSNA 2010 in Chicago that any single communication method, by itself, was too unreliable. "E-mail has too many gaps in documentation. Paging is inefficient and disruptive. There are simply too many ways that communication can break down."

A study conducted by BWH in 2006, for example, showed that only 30 percent of the results deemed critical findings were being communicated in a timely fashion in accordance with the hospital's guidelines.

The Alert Notification of Critical Radiology Results (ANCR) now implemented at BWH enables radiologists to stratify results in three categories: Red (must be reported in 60 minutes); Orange (3 hours); and Yellow (3 days).

ANCR is integrated with the PACS, e-mail and paging systems throughout BWH. If a red or orange alert is logged into the system, a request for an immediate phone conversation or face-to-face meeting is sent out. For yellow alert, an e-mail is sent out, but the e-mail requires the referring physician to log into the ANCR system and then documents that access.

ANCR pulls all available data from the PACS into a report so there are no gaps in documentation between radiologists and referring physicians, Khorasani explained. In addition, the worklists in ANCR document which alerts have been reviewed by referring physicians and indicates via a flashing alert on the desktop if results haven't been reviewed in the timeframe established by the hospital.

Khorasani said that BWH radiologists are communicating critical results in accordance with hospital guidelines 90 percent of the time, compared with 25 percent before ANCR was implemented. The median time of acknowledgement of Red and Orange critical findings by referring physicians was three minutes.

--Greg Gillespie


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