Honig S E, Honig E L, Babiarz L B, Lewin J S, Berlanstein B, Yousem D M
From the Division of Neuroradiology, The Russell H. Morgan Department of Radiology and Radiological Science, The Johns Hopkins Medical Institutions, Baltimore, Maryland.
AJNR Am J Neuroradiol. 2014 Aug;35(8):1485-92. doi: 10.3174/ajnr.A3918. Epub 2014 Apr 10.
Timely reporting of critical findings in radiology has been identified by The Joint Commission as one of the National Patient Safety Goals. Our aim was to determine the magnitude of delays between identifying a neuroradiologic critical finding and verbally notifying the caregiver in an effort to improve clinical outcomes.
We surveyed the time of critical finding discovery, attempted notification, and direct communication between neuroradiologists and caregivers for weekday, evening, overnight, and weekend shifts during an 8-week period. The data were collected by trained observers and/or trainees and included 13 neuroradiology attendings plus fellows and residents. Critical findings were based on a previously approved 17-item list. Summary and comparative t test statistics were calculated, and sources of delays were identified.
Ninety-one critical findings were recorded. The mean time from study acquisition to critical finding discovery was 62.2 minutes, from critical finding discovery to call made 3.7 minutes, and from call made to direct communication, 5.2 minutes. The overall time from critical finding discovery to caregiver notification was within 10 minutes in 72.5% (66/91) and 15 minutes in 93.4% (85/91) of cases. There were no significant differences across shifts except for daytime versus overnight and weekend shifts, when means were 2.4, 5.6, and 8.7 minutes, respectively (P < .01). If >1 physician was called, the mean notification time increased from 3.5 to 10.1 minutes (P < .01). Sources of delays included inaccurate contact information, physician unavailability (shift change/office closed), patient transfer to a different service, or lack of responsiveness from caregivers.
Direct communication with the responsible referring physician occurred consistently within 10-15 minutes after observation of a critical finding. These delays are less than the average interval from study acquisition to critical finding discovery (mean, 62.2 minutes).
美国医疗机构评审联合委员会已将及时报告放射学危急结果确定为全国患者安全目标之一。我们的目的是确定识别神经放射学危急结果与口头通知护理人员之间的延迟程度，以改善临床结局。
我们调查了8周内工作日、傍晚、夜间和周末班次中神经放射科医生发现危急结果的时间、尝试通知的时间以及与护理人员的直接沟通时间。数据由经过培训的观察员和/或实习生收集，包括13名神经放射科主治医师以及住院医师和实习医师。危急结果基于先前批准的17项清单。计算了汇总统计数据和比较t检验统计量，并确定了延迟的来源。
记录了91项危急结果。从获取检查到发现危急结果的平均时间为62.2分钟，从发现危急结果到打电话的时间为3.7分钟，从打电话到直接沟通的时间为5.2分钟。在72.5%（66/91）的病例中，从发现危急结果到通知护理人员的总时间在10分钟内，在93.4%（85/91）的病例中在15分钟内。除白天与夜间及周末班次外，各班次之间无显著差异，白天、夜间和周末班次的平均时间分别为2.4分钟、5.6分钟和8.7分钟（P <.01）。如果呼叫了多名医生，平均通知时间从3.5分钟增加到10.1分钟（P <.01）。延迟的来源包括联系信息不准确、医生无法联系（换班/办公室关闭）、患者转至其他科室或护理人员无响应。
在观察到危急结果后，与负责的转诊医生的直接沟通通常在10 - 15分钟内进行。这些延迟短于从获取检查到发现危急结果的平均间隔时间（平均62.2分钟）。
