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TEST RESULTS
From Critical to Incidental Findings
CRITICAL TEST RESULTS MANAGEMENT
Speeding care by sending critical test results to ordering physicians quickly
• Improve care
• Reduce wasted time
• Protect patient information
• Avoid litigation
HEALTHCARE MARKET DYNAMICS
Reducing litigation expense is a major driver for CTRM systems• Est. 98,000 U.S. patients die
each year due to medical errors, often communication errors
• “Of malpractices cases... 75% are communication related”
Source: www.healthimaging.com April 7, 2009. Critical test-result management systems help reduce malpractice suits.
THE COST OF POOR COMMUNICATIONS
“Brigham and Women’s Hospital spent between $35 and $40 million during a five-year period resolving lawsuits involving radiologists. Failure to communicate findings represented 20% of the lawsuits.”
– Vice Chair of Radiology at Brigham and Women’s Hospital
Source: www.auntminnie.com June 5, 2009. Critical results software – it’s cheaper than settling lawsuits
THE CHALLENGE: TIME TO DELIVER RESULTS
Results are critical - Sue’s physician must
be notified
Results entered into hospital’s results
system
• After some phone tag, Radiology speaks with Dr. Jones about Sue
• Dr. Jones recognizes the need for immediate treatment
• He must contact the appropriate physician for immediate action
Sue’s physician, Dr. Jones orders a radiological exam
Radiology techs attempt to contact Dr.
Jones
25 MINUTES TIME TO COMPLETE THE PROCESS:
START
SPEEDING RADIOLOGY RESULTS WITH SPOK
WITHOUT SPOK: 25 MINUTES TIME TO COMPLETE THE PROCESS:
START
WITH SPOK: 3 MINUTES
Results entered into Spok CTRM system
• Results sent directly to physician's device
• Message transmitted securely
• Includes audit trail
• Physician is able to take immediate action
• Spok system can message directly to Sue’s nurse on her wireless IP phone
• Request can be made to administer appropriate medication
Sue’s physician, Dr. Jones orders a radiological exam
EMR Sue Smith
Results are critical - Sue’s physician must
be notified
Radiologist selects and opens exam from PACS
worklist
Radiologist interprets image
and dictates exam report
Radiologist clicks on Spok CTRM
from PACS Menu Bar
Radiologist selects acuity level from
Spok CTRM pop-up window
Radiologist selects template
notification
Radiologist adds additional instruction
to notification and publishes the Critical
Finding
Radiologist closes exam and moves on
Spok sends notification to
Ordering Physician and other care team
members
Ordering Physician Accepts and calls back to consult with Radiologist
All activity saved in Spok
audit trail
CRITICAL RESULTS WORKFLOW - TRANSCRIPTION
Radiological exam is performed, and results are available via the PACS
.
RIS/PACS
Radiologist selects and opens exam from PACS
worklist
Radiologist interprets image and dictates exam report
into VR System
Radiologist initiates a Spok CTRM critical
finding by using voice command indicating
Acuity level
Radiologist closes exam and moves on
Spok CTRM automatically lifts the
impression with finding and acuity level from the
HL7 result message
Spok sends notification to
Ordering Physician and other care team
members
Ordering Physician Accepts and calls back to consult with Radiologist
All activity saved in Spok
audit trail
CRITICAL RESULTS WORKFLOW – VR SYSTEM INTEGRATION
Radiological exam is performed, and results are available via the PACS
.
RIS/PACS
THE CHALLENGE: READINGS DISCREPANCY
Radiological exam is performed, and results are available via the PACS
.
ED physician views results first, and makes a preliminary interpretation.
Notes are written on piece of paper.
Radiologist then reviews exam, and his diagnosis differs from the ED physician’s findings.
PACSRadiologist then needs to contact the ED physician to discuss discrepancy
.
Time Delay.
Radiologist reviews paper-based notes
ED physician makes preliminary read and enters notes in Spok
CTRM or EDIS (if integrated)
Radiologist selects and
opens exam from PACS worklist
Spok CTRM pops up with
preliminary read
Radiologist interprets image
and finds a discrepancy
Radiologist selects discrepancy
acuity level from Spok CTRM
Radiologist adds additional instruction
and publishes the Discrepancy
Radiologist dictates remainder
of report and moves on
Spok sends notification to ED physician only if
discrepancy found
ED Physician Accepts and
takes appropriate corrective action
All activity saved in Spok
audit trail
OVERCOMING READINGS DISCREPANCY
Radiological exam is performed, and results are available via the PACS
.
RIS/PACS
THE CHALLENGE: TIME TO DELIVER CRITICAL LAB RESULTS
• After some phone tag, Lab speaks with Dr. Jones about Sue
• Dr. Jones recognizes the need for immediate treatment
• He must contact the appropriate physician for immediate action
WITHOUT SPOK: 25 MINUTES TIME TO COMPLETE THE PROCESS:
START
Results entered into hospital’s results
system
Laboratory techs attempt to contact Dr.
Jones
Lab results are critical - ordering physician must be notified
.
Sue’s physician, Dr. Jones orders lab tests
SPEEDING CRITICAL LAB RESULTS WITH SPOK
• Results sent directly to physician's device
• Alert message is transmitted securely
• Physician is able to close the loop
• Alert will escalate in 15, 30, 60 min if the loop is not closed
• Escalation period can be configured by the hospital
• Results can be sent to multiple devices and multiple caregivers
WITHOUT SPOK: 30 MINUTES TIME TO COMPLETE THE PROCESS:
START
WITH SPOK: 3 MINUTES
Lab results are critical - ordering physician must be notified
.
Sue’s physician, Dr. Jones orders lab tests
EMR Audit Trail
Radiology / Cardiology / Pathology
AN ALERT CAN BE SENT TO: INFORMATION CAN INCLUDE:• Reports• Images• Annotations• Voice clips• Handwritten notes
ALERTS
Results entered into Spok CTRM system
CARE PROVIDER WEB ACCESS TO CTRM
Patient Care Team
Hospitalist
Techs
Nurses
ED Periop
ReferringPhysicians Specialist
s
`
RESULTS ONLY MATTER IF THEY’RE RECEIVED
Of test results specifically cited as a factor in a malpractice case:
• Most common problem: Patient didn’t receive test results
• Second-most-common problem: Clinician didn’t receive the results
Journal of the American College of Radiology, Volume 8, Issue 11 , Pages 776-779, November 2011
MEDICAL MALPRACTICE STUDY
Failure to Notify Reportable Test Results:
• Significance in Medical Malpractice
• Examined medical malpractice claims from 425 hospitals and 52,000 providers
Key Findings:
• Past Decade: Rapid growth of diagnostic testing puts physicians at greater risk for medical malpractice claims for test communication failures
• 1996 – 2003: Malpractice payments related to diagnosis 40%
REAL LIFE EXAMPLE — PEGGY KIDWELL3
• Mix-up over doctors’ names led to a year-long delay in a breast cancer diagnosis
• By the time it was discovered, her cancer had spread to her chest wall
• Kidwell filed a malpractice lawsuit and eventually settled the case
3Michelle Andrews. "Medical tests are pointless when results don’t reach the doctor or the patient.” The Washington Post National. Editor(s) of website. 28 Nov. 2011. Associated institution. 9 Mar 2012. <http:www.washingtonpost.com >.
INCONSISTENCIES ABOUND
According to a study in the January 2012 edition of Archives of Internal Medicine:• 69.3% of primary care physicians said they send specialists
notification of patients' histories all or most of the time
– Only 34.8% of specialists said they routinely receive such information
• Among specialists, 80.6% said they send consultation results to the referring physician all or most of the time
– Only 62.2% of primary care physicians reported ever receiving consultation results
CRITICAL TEST RESULTS MANAGEMENT
JOINT COMMISSIONNATIONAL PATIENT SAFETY GOAL #2Satisfies
Improve the effectiveness of communication among caregivers
MANAGE THE CTRM PROCESS
• CTRM Dashboard for PACS Admins and RADs
– View active notifications with status
• INSTANT AUDIT TRAIL
– Tracks all notifications through completion
– Export via HL7 to EMR to close the loop
• CTRM Analytics
– Sender/Receiver Activity Reports
– Average Time to Close Alerts
– Violations vs. Target Report
CASE STUDY:TUOMEY REGIONAL MEDICAL CENTER
• Improved patient care and sped treatment and discharge with faster communication of test results and incidental findings
• Reduced time physicians wasted calling around for test results or clarifications
• Developed a communications audit trail ready for Joint Commission visits“During the three months immediately following implementation, we saw an 11% improvement in patient discharge times.”
– José Bennett, PACS Administrator, Tuomey Healthcare System
ED physician listens to recording of Radiologist's findings, and
acknowledges having viewed the result on the Spok CTRM workstation.
Radiological exam is performed - Radiologist
speaks results into mic to initiate the results delivery
process.
Result appears in the ED workstation
Time saved in delivering the result, as Radiologist and ED physician do not have to play phone tag to speak and discuss findings
ED physician can view scan in PACS directly
from Spok CTRM workstation
CASE STUDY:TUOMEY REGIONAL MEDICAL CENTER
CASE STUDY:QUINTE HEALTH CARE
• Send test results from the Laboratory, Radiology, and Cardiopulmonary departments to ordering physicians
• Streamline communication of results to ER physicians
– Improve ER patient flow and minimize ER wait times
“We chose [Spok] because it’s not a cookie-cutter solution; we can tailor it to QHC. It works in all the diagnostic areas we report for —Cardiopulmonary, Radiology, and the Laboratory, and will provide efficiencies in the diagnostics and ER departments alike.”
– Dianna Kiss, PACS Coordinator, Quinte Health Care
Physician receives notification of the alert on their smartphone or pager -
can view alert and acknowledge from a PC
Radiologist uses dictation mic to record findings, indicate acuity level,
and initiate alerting process
Spok CTRM transfers closed alert info to Meditech EMR system
CASE STUDY:QUINTE HEALTH CARE
CASE STUDY:EMH HEALTHCARE
• Time savings and improved patient safety by alerting staff and posting results into the patient’s electronic medical record (EMR)
• Meets Joint Commission guidelines on communicating critical test results more efficiently“The ER doctors immediately see an alert on the EMR dashboard. As a result, communications are smoother and our ER process is now much less manual. We have also eliminated the need for radiology nurses to track reports and dictations, maintain a document log, and make calls to notify ER physicians.”
– Michelle Dossa, Manager, Department of Imaging Services, EMH Healthcare
Charge nurse carrying dedicated pager receives any escalations from Spok CTRM
system
Alert appears in the ED on the ED Information System (Siemens Syngo).
ED physician is able to view results and acknowledge
Radiologist initiates alerting process via Agfa PACS - opens
Spok CTRM app for Radiologist to select acuity
level.
Spok CTRM transfers closed alert info to Allscripts EMR system
CASE STUDY:EMH HEALTHCARE
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