With lab result success, other departments follow
Once the lab at Mount Auburn Hospital in Cambridge, MA, met its goal of communicating first-time critical results to the physician in less than 60 minutes, 100% of the time, the next step was to take the policy to other departments. Radiology and cardiology were next in line, says Susan A. Abookire, MD, MPH, chair of quality and safety at Mount Auburn.
Each of these areas created specific critical value lists and policies and explicit time frames for calling critical results, where previously none had existed. All lists and policies now are reviewed/evaluated annually or as needed, with approval from the Medical Staff Executive Committee. Critical value lists and categories were placed in "reading stations" in common areas so staff could study them and refer to them as needed.
In radiology, a change to the computer system helped improve reporting times, she says.
"This change allowed all information collected during patient registration to automatically cross over from our admitting module to our radiology module, thereby giving the interpreting physician information on who to call with their final result, which improved our turnaround times in radiology," Abookire says.
Additionally, radiology monitors all positive tests, not just those determined to be critical. The current monitoring process is that all positive results are called at the time the study is being read. If contact is immediately made, this contact is documented in the official dictated report. To make sure that all positive and critical results are reported to the appropriate physician, the billing slip is held aside until the contact has been made.
Documentation in the report that the radiologist has discussed the case with the ordering physician is considered to comply with the "read-back" requirements, Abookire notes. If a result is given to a covering physician, a formal read-back including the patient's name and the findings is expected.
Prior to this initiative, the cardiology department had no formal criteria for calling critical results. Individual interpreting cardiologists decided what a "critical result" was and what needed to be called, Abookire says. Nurses and techs performing stress tests, echocardiograms, vascular exams, and Holter monitors also independently decided if something was to be brought to the attention of a cardiologist for stat interpretation. Documentation of results reported varied, and inconsistencies existed as to what results should be considered critical and called within one hour.
The cardiology department followed the lead of the lab and radiology and devised a set of critical results that must be reported immediately. All cardiology critical results are documented in a log book and monitored monthly, she says.
Once the lab at Mount Auburn Hospital in Cambridge, MA, met its goal of communicating first-time critical results to the physician in less than 60 minutes, 100% of the time, the next step was to take the policy to other departments.You have reached your article limit for the month. Subscribe now to access this article plus other member-only content.
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