Regulatory agencies have set a 60-minute window to communicate positive CT PE (computed tomography pulmonary embolism) results to ordering providers. Improving the effectiveness of communication among caregivers for critical results of tests is a national patient safety goal. Our current system of communicating positive results to providers was inconsistent (mean time to verbal report 48 minutes, standard deviation 168 minutes) and unsatisfactory (55% radiologists satisfied with process of communicating positive PE studies).
1. Identify process improvement opportunities in our existing process of communicating positive CT PE results
2. Design and implement iterative improvements in our existing process without negatively impacting workflow
3. Create a more efficient, reliable and stable system to communicate positive CT PE results to ordering providers
4. Improve stakeholder satisfaction with the process of communicating positive CT PE results
A multidisciplinary team representing all relevant stakeholders was convened. Team champions from radiology and medicine administration leadership ensured adequate buy in and support. Radiologists were surveyed to ascertain their knowledge of the 60-minute window and to identify barriers to timely communication of positive CT PE results. A root cause analysis determined the primary issues to be centered on identification and track down of appropriate clinician taking care of the patient. Radiologists’ awareness of the 60-minute window was identified as an area of improvement as well. Subsequent solutions were tested through multiple PDSA cycles. A new electronic health record order set for CT PE studies was created that would maximize radiologist’s ability to reach the right provider while minimizing disruption to clinical work flow on the wards. Existing resources, such as the access center and radiology liaison, were strategically inserted into the algorithm used by radiologists to identify the right providers while redundant steps were eliminated. Radiologists were educated on knowledge and utilization of resources available to identify the correct ordering providers.
We eliminated 50% of process steps used by radiology in obtaining and reporting positive CT PE results to clinicians. Proportion of studies communicated to clinicians within 60 minutes of end of exam increased from 87.8% (N=41, mean time to report 45.37 minutes, standard deviation 164.50 minutes) to 97.62% (N=42, mean time to report 18.07 minutes, standard deviation 17.58 minutes). Ordering providers rated the new order set at 4.4/5 for ease of use and at 3.9/5 on workflow. Radiologist satisfaction with critical result communication process for CT PE studies increased from 3.48/5 to 4/5, while radiologist knowledge of the 60-minute time window for reporting critical CT PE results increased from 39% to 78% of those surveyed.
A multidisciplinary, systematic approach grounded in sound quality improvement principles that involved all relevant stakeholders resulted in identification and implementation of low cost and high impact interventions that were well received by end users and helped solve a common problem at our institution. The new process is more efficient and more reliable and has been well received by stakeholders in the process. This translates into less value added work for individuals involved in the process and reduces the opportunities for errors. The new process is now firmly integrated into our daily workflow.
To cite this abstract:Segon, A; Beaudry, J; Emanuel, C; Gorman, A; Laste, Z; Mack, T . COMMUNICATING POSITIVE CT PE RESULTS-A TEAM BASED SOLUTION TO A COMMON PROBLEM AT OUR INSTITUTION. Abstract published at Hospital Medicine 2017, May 1-4, 2017; Las Vegas, Nev. Abstract 211. Journal of Hospital Medicine. 2017; 12 (suppl 2). https://www.shmabstracts.com/abstract/communicating-positive-ct-pe-results-a-team-based-solution-to-a-common-problem-at-our-institution/. Accessed May 20, 2019.