Critical Test Results Radiology as a case example - Safetyleaders.org
Critical Test Results Radiology as a case example - Safetyleaders.org
Critical Test Results Radiology as a case example - Safetyleaders.org
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<strong>Critical</strong> <strong>Test</strong> <strong>Results</strong><br />
<strong>Radiology</strong> <strong>as</strong> a c<strong>as</strong>e <strong>example</strong><br />
Ramin Khor<strong>as</strong>ani, MD, MPH<br />
Vice Chair, Department of <strong>Radiology</strong><br />
Director, Center for Evidence-B<strong>as</strong>ed Imaging<br />
Director, Medical Imaging IT<br />
Brigham and Women’s Hospital<br />
Ramin Khor<strong>as</strong>ani, MD, MPH<br />
Associate Professor<br />
Harvard Medical School
What does this safe practice address?<br />
• Optimal communication of clinical information<br />
among caregivers-- ‘closing the loop’<br />
• Suboptimal communication of critical test results<br />
can lead to delayed diagnosis, treatment and<br />
harm to patients<br />
– E.g. abnormal mammogram<br />
Ramin Khor<strong>as</strong>ani, MD, MPH
• Leadership<br />
How?<br />
People<br />
– Is quality and safety part of your DNA?<br />
– Is it expressed?<br />
– CEO, CMO, patient safety officers, clinical leaders<br />
– Clinical leadership-Chair in radiology<br />
• Change management skills<br />
– Why? Why now? Vision?<br />
Communication….Institutionalizing change<br />
– Leading Change HBR March 1995<br />
Ramin Khor<strong>as</strong>ani, MD, MPH
How?<br />
Process<br />
• Building team<br />
• Define policy and procedure<br />
• Communicate<br />
• Me<strong>as</strong>ure, me<strong>as</strong>ure, me<strong>as</strong>ure…<br />
• Implement<br />
• Me<strong>as</strong>ure, me<strong>as</strong>ure, me<strong>as</strong>ure…<br />
• Control gains, improve<br />
• Me<strong>as</strong>ure, me<strong>as</strong>ure, me<strong>as</strong>ure…<br />
Ramin Khor<strong>as</strong>ani, MD, MPH
What? Need policies and procedures<br />
(include definitions/me<strong>as</strong>ures):<br />
• What is critical test result<br />
• Categories of critical results:<br />
– E.g. Immediately life threatening, urgent, other<br />
• Time-frame per category for communication to care-giver<br />
• Verifiable method of communication-<br />
– To ensure critical nature of result is understood<br />
– No emails<br />
• Escalation procedures for communication<br />
• Detailed documentation of communication in the finalized<br />
radiology report-must be auditable<br />
• Metric for compliance with policy<br />
• Interventions for improvement-me<strong>as</strong>ure<br />
Ramin Khor<strong>as</strong>ani, MD, MPH
Policies and procedures<br />
• Notification and tracking of critical results.doc<br />
Ramin Khor<strong>as</strong>ani, MD, MPH
How?<br />
Technology<br />
• Technology: We must have a systems approach, but<br />
can’t wait- MUST START NOW -will improve with<br />
technology<br />
• Technology solutions, integration standards EXIST<br />
TODAY<br />
– Need to promote and encourage their adoption<br />
– [Optimal Electronic Medical Records will be virtual solutions,<br />
integrated b<strong>as</strong>ed on standards to promote patient-centered,<br />
evidence-b<strong>as</strong>ed innovations]<br />
– Broader adoption will continue to mature solutions to better<br />
serve our patients and the quality and safety movement<br />
Ramin Khor<strong>as</strong>ani, MD, MPH
Technology: What can you do?<br />
• As leaders, get involved in technology decision makingthey<br />
are quality and safety NOT IT decisions- you must<br />
be accountable<br />
• Demand, purch<strong>as</strong>e, adopt patient-centered, evidenceb<strong>as</strong>ed<br />
solutions that are enabled with integration<br />
standards<br />
– When you settle for less you put your patients at risk<br />
• The right technology solutions will reduce w<strong>as</strong>te and<br />
find the money in your practice to fund tomorrow’s<br />
quality and safety improvements<br />
Ramin Khor<strong>as</strong>ani, MD, MPH
Finally:<br />
‘Closing the loop’<br />
• It is all about Leadership<br />
• Clinical leadership-<br />
– Chair in radiology<br />
– Quality and safety<br />
– Other Chairs<br />
Ramin Khor<strong>as</strong>ani, MD, MPH
Thank You!<br />
rkhor<strong>as</strong>ani@partners.<strong>org</strong><br />
http://cebi.partners.<strong>org</strong><br />
Ramin Khor<strong>as</strong>ani, MD, MPH
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