title: Radiologist compliance with institutional guidelines for use of nonroutine communication of diagnostic imaging results.
abstract: OBJECTIVE
  The aim of this study was to evaluate radiologist compliance with institutional guidelines for nonroutine communication of diagnostic imaging results.
  
  
  METHODS
  From July 2012 through September 2013, 7,401 completed advanced imaging cases were retrospectively reviewed by groups of 3 or more radiologists. The reviewing radiologists were asked to reach consensus on two questions related to nonroutine communication: (1) "Does the report describe a finding which requires nonroutine communication to the patient's physicians?" and if so, (2) "Were the department's guidelines for nonroutine communication followed?" Consensus judgments were aggregated and analyzed on the basis of subspecialty, level of acuity per the guidelines, and type of communication used.
  
  
  RESULTS
  Of the 7,401 studies reviewed, 960 (13.0%) were deemed to require nonroutine results communication. The need for nonroutine communication was most frequent with CT (16.6%), followed by MRI (11.1%) and ultrasound (3.4%). For the divisions studied, nonroutine communication was most frequently needed in thoracic (37.9%), followed by neurologic (17.3%), emergency (15.8%), cardiac (13.7%), musculoskeletal (4.4%), and abdominal (0.7%) imaging. Of the cases requiring nonroutine communication, 39 (4%) yielded consensus that the guidelines were not appropriately followed: 21% (n = 8) involved level 1 findings (critical), 41% (n = 16) involved level 2 findings (acute), and 38% (n = 15) involved level 3 findings (nonacute). Failures of communication involving level 1 findings primarily involved neurologic imaging, including 4 cases of new cerebral infarct and 3 cases of new intracranial hemorrhage.
  
  
  CONCLUSIONS
  Established guidelines for nonroutine communication are appropriately applied and durable, underscoring the high yield of formalizing and implementing these guidelines across practice settings.
authors.affiliation: Department of Radiology, Massachusetts General Hospital, Boston, Massachusetts; Harvard Medical School, Boston, Massachusetts. Electronic address: hbharvey@partners.org.
authors.forename: H Benjamin
authors.initials: HB
authors.lastname: Harvey
authors.affiliation: Department of Radiology, Massachusetts General Hospital, Boston, Massachusetts; Harvard Medical School, Boston, Massachusetts.
authors.forename: Tarik K
authors.initials: TK
authors.lastname: Alkasab
authors.affiliation: Department of Radiology, Massachusetts General Hospital, Boston, Massachusetts; Harvard Medical School, Boston, Massachusetts; Institute for Technology Assessment, Massachusetts General Hospital, Boston, Massachusetts.
authors.forename: Pari V
authors.initials: PV
authors.lastname: Pandharipande
authors.affiliation: Harvard School of Public Health, Cambridge, Massachusetts.
authors.forename: Jing
authors.initials: J
authors.lastname: Zhao
authors.affiliation: Department of Radiology, Massachusetts General Hospital, Boston, Massachusetts; Harvard Medical School, Boston, Massachusetts; Institute for Technology Assessment, Massachusetts General Hospital, Boston, Massachusetts.
authors.forename: Elkan F
authors.initials: EF
authors.lastname: Halpern
authors.affiliation: Department of Radiology, Massachusetts General Hospital, Boston, Massachusetts; Harvard Medical School, Boston, Massachusetts.
authors.forename: Gloria M
authors.initials: GM
authors.lastname: Salazar
authors.affiliation: Department of Radiology, Massachusetts General Hospital, Boston, Massachusetts; Harvard Medical School, Boston, Massachusetts.
authors.forename: Hani H
authors.initials: HH
authors.lastname: Abujudeh
authors.affiliation: Department of Radiology, Massachusetts General Hospital, Boston, Massachusetts; Harvard Medical School, Boston, Massachusetts.
authors.forename: Daniel I
authors.initials: DI
authors.lastname: Rosenthal
authors.affiliation: Department of Radiology, Massachusetts General Hospital, Boston, Massachusetts; Harvard Medical School, Boston, Massachusetts; Institute for Technology Assessment, Massachusetts General Hospital, Boston, Massachusetts.
authors.forename: G Scott
authors.initials: GS
authors.lastname: Gazelle
mesh_terms: D001900:Boston; D003142:Communication; D003952:Diagnostic Imaging / Q000592:standards* / Q000706:statistics & numerical data*; D019983:Guideline Adherence / Q000706:statistics & numerical data*; D033181:Information Dissemination; D017410:Practice Guidelines as Topic; D010818:Practice Patterns, Physicians' / Q000592:standards / Q000706:statistics & numerical data*
keywords: Joint Commission; Radiology; critical results; nonroutine communication; quality and safety