Deployment of Enhanced Critical Imaging Result Notification (DECIRN)

描述（由申请人提供）：联合委员会强调需要改善关键试验结果的沟通，作为其2010年国家患者安全目标之一。关键结果沟通的延迟造成诊断延误，最终导致管理延误，从而对患者安全构成重大威胁。在诊断成像中，目前还没有关于结果交流的及时性、理想的交流场所、特别是决定哪些结果是关键的标准。布里格姆妇女医院循证成像中心制定了一项全企业范围的政策，作为三年质量改进计划的一部分，以加强关键成像结果的沟通。该政策包括明确的指导方针和程序通知转诊医生每当关键的影像学结果确定。在一项试点研究中，完全遵循这一政策的关键结果比例在三年内从28.6%增加到94.6%。然而，该试点评估需要对个别报告进行人工审查，因此在三年内仅审查了12,193份报告（不到1%）。全面的评估将为这项政策的成功实施和采用提供更明确的信息，因此拟议的项目计划以下具体目标：(1)实施全企业范围的政策和干预措施，以加强关键成像结果的沟通；(2)通过比较其对关键成像结果的适当警报通知的影响和干预错过的记录关键结果来评估该干预措施；(3)制定广泛传播的实施工具包。在项目开始之日，将开始实施CCTR政策，并全面部署关键结果自动通知系统（ANCR）。为了评估增强关键成像结果通知（DECIRN）的部署，我们将进行一项前瞻性单交叉临床试验，将干预措施与基线临床实践进行比较。每年在BWH及其门诊设施进行超过60万次成像手术，全面实施这一政策将极大地促进患者安全并鼓励广泛采用。最后，将分发一个实施工具包，其中包括一份完整的资源指南，使其他机构能够采用CCTR政策，并在可能的情况下启用自动通知。

DESCRIPTION (provided by applicant): The Joint Commission has emphasized the need for improved communication of critical test results as one of its 2010 National Patient Safety Goals. Delays in communication of critical results pose a significant threat to patient safety by creating delays in diagnosis, which eventually leads to delays in management. In diagnostic imaging, no standards currently exist for timeliness of communication of results, for ideal communication venues, and especially for deciding which results are critical. The Brigham and Women's Hospital Center for Evidence-Based Imaging established an enterprise-wide policy as part of a three-year quality improvement initiative to enhance communication of critical imaging results. The policy includes clear guidelines and procedures for notification of referring physicians whenever critical imaging results are identified. In a pilot study, the proportion of critical results fully adherent with this policy increased from 28.6% to 94.6% over three years. This pilot evaluation, however, required manual review of individual reports and therefore only reviewed 12,193 reports in three years (less than 1%). A full-scale evaluation would provide more definitive information regarding successful implementation and adoption of this policy The proposed project therefore plans the following specific aims: (1) Implement an enterprise-wide policy and intervention for enhancing communication of critical imaging results; (2) Evaluate this intervention by comparing its impact on appropriate alert notification for critical imaging results and documented critical results that were missed by the intervention; and (3) Develop an implementation toolkit for widespread dissemination. Implementation of the CCTR policy with full deployment of an Automated Notification of Critical Results system (ANCR) will commence at the project start date. In order to evaluate the deployment of enhanced critical imaging result notification (DECIRN), we will undertake a prospective single crossover clinical trial, comparing the intervention with baseline clinical practice. With over 600,000 imaging procedures performed at the BWH and its outpatient facilities annually, fully implementing this policy would greatly promote patient safety and encourage widespread adoption. Finally, an implementation toolkit will be disseminated, which includes a full resource guide to enable other institutions to adopt the CCTR policy and enable automated notification when possible. PUBLIC HEALTH RELEVANCE: Delays in communication of critical results pose a significant threat to patient safety by creating delays in diagnosis, which eventually leads to delays in management. The Brigham and Women's Hospital (BWH) established the Communication of Critical Test Results (CCTR) policy to enhance communication of critical imaging results. This study aims to deploy an enhanced, automated implementation of this policy using Automated Notification of Critical Results, an automated critical imaging result management system to promote patient safety and encourage widespread adoption.