title: Improving Patient Safety: Avoiding Unread Imaging Exams in the National VA Enterprise Electronic Health Record.
abstract: In the current digital and filmless age of radiology, rates of unread radiology exams remain low, however, may still exist in unique environments. Veterans Affairs (VA) health care systems may experience higher rates of unread exams due to coexistence of Veterans Health Information Systems and Technology Architecture (VistA) imaging and commercial picture archiving and communication systems (PACS). The purpose of this patient safety initiative was to identify any unread exams and causes leading to unread exams. Following approval by departmental quality assurance committee, a comprehensive review was performed of all radiology exams within VistA imaging from July 1, 2009 to June 30, 2014 to identify unread radiology exams. Over the 5-year period, the total unread exam rate was calculated to be 0.17%, with the highest yearly unread exam rate of 0.25%. The leading majority of unread exam type was plain radiographs. Analysis revealed unfinished dictations, unassociated accession numbers, technologist errors, and inefficient radiologist work lists as top contributors to unread exams. Once unread radiology exams were discovered and the causes identified, valuable process changes were implemented within our department to ensure simultaneous tracking of all unread exams in VistA imaging as well as the commercial PACS.
authors.affiliation: Department of Radiology, VA Puget Sound Health Care System and University of Washington School of Medicine, Seattle, Washington. 1660 S Columbian Way, Seattle, WA, 98108, USA. ssheikh@uw.edu.|Department of Radiology, University of Washington Medical Center, 1959 NE Pacific Street, Seattle, WA, 98195, USA. ssheikh@uw.edu.
authors.forename: Sarah
authors.initials: S
authors.lastname: Bastawrous
authors.affiliation: Department of Radiology, University of Washington Medical Center, 1959 NE Pacific Street, Seattle, WA, 98195, USA.
authors.forename: Benjamin
authors.initials: B
authors.lastname: Carney
mesh_terms: D000792:Angiography / Q000706:statistics & numerical data; D057286:Electronic Health Records; D006787:Hospitals, Veterans / Q000706:statistics & numerical data*; D006801:Humans; D008279:Magnetic Resonance Imaging / Q000706:statistics & numerical data; D061214:Patient Safety; D011859:Radiography / Q000706:statistics & numerical data; D011872:Radiology Department, Hospital; D011873:Radiology Information Systems / Q000706:statistics & numerical data*; D011877:Radionuclide Imaging / Q000706:statistics & numerical data; D013997:Time Factors; D014057:Tomography, X-Ray Computed / Q000706:statistics & numerical data; D014463:Ultrasonography / Q000706:statistics & numerical data
keywords: Electronic Medical Record (EMR); PACS; Quality assurance; Unread exams