title: Impact of a 4-year quality improvement initiative to improve communication of critical imaging test results.
abstract: OBJECTIVE
  To evaluate the impact of a 4-year initiative to develop, implement, monitor, and reinforce a communication of critical test results policy by using continuous-process improvement methods.
  
  
  METHODS
  This HIPAA-compliant quality-improvement initiative was performed between February 2006 and January 2010. Institutional review board approval was received with waiver of informed consent for medical record reviews. A critical results policy for radiology was developed that was based on recommendations from the Joint Commission, American College of Radiology, and Massachusetts Coalition for the Prevention of Medical Errors. It defined types of findings (critical or discrepant), urgency level (red, orange, or yellow), timelines for notification, acceptable communication and documentation methods, and a communication escalation process. The primary outcome measure, adherence to the communication of critical results policy, was measured by periodic review of radiology reports with feedback of results to staff radiologists. The χ(2) statistic was used to assess for trends.
  
  
  RESULTS
  During 21 quality reviews, 16,983 of 1,489,951 (1.14%) total radiology reports were reviewed, 1628 (9.6%) of which were assessed to contain critical results according to policy. Adherence to critical results policy increased from 28.6% (12 of 42) in February 2006 to 90.4% (122 of 135) by the end of the study period (P < .001), with most of the gains occurring in the first 2 years.
  
  
  CONCLUSIONS
  Review and feedback of performance in regard to a policy on communication of critical imaging test results allowed significant improvement and sustained adherence to policy.
  
  
  BACKGROUND
  http://radiology.rsna.org/lookup/suppl/doi:10.1148/radiol.11101396/-/DC1.
authors.affiliation: Center for Evidence-Based Imaging, Brigham and Women's Hospital, 20 Kent St, Brookline, MA 02445, USA.
authors.forename: Shawn G
authors.initials: SG
authors.lastname: Anthony
authors.forename: Luciano M
authors.initials: LM
authors.lastname: Prevedello
authors.forename: Maria M
authors.initials: MM
authors.lastname: Damiano
authors.forename: Tejal K
authors.initials: TK
authors.lastname: Gandhi
authors.forename: Peter M
authors.initials: PM
authors.lastname: Doubilet
authors.forename: Steven E
authors.initials: SE
authors.lastname: Seltzer
authors.forename: Ramin
authors.initials: R
authors.lastname: Khorasani
mesh_terms: D016009:Chi-Square Distribution; D003142:Communication; D003952:Diagnostic Imaging / Q000592:standards*; D004282:Documentation; D006801:Humans; D008404:Massachusetts; D017064:Process Assessment, Health Care / Q000379:methods*; D016730:Program Development; D015397:Program Evaluation; D058996:Quality Improvement; D011872:Radiology Department, Hospital / Q000458:organization & administration*