Automated Notification System for Follow-Up Testing Recommendations Across Care S

描述（由申请人提供）：联合委员会强调需要改善关键检测结果的沟通，作为国家患者安全目标（NPSG）。这一目标包括随后实施管理关键测试结果的后续程序。布里格姆妇女医院循证成像中心制定了一项企业范围的政策，作为为期三年的质量改进计划的一部分，以加强关键成像结果的沟通。由AHRQ部分资助的通知系统为这一工作提供了便利，该系统在影像学检查结果被放射科医生在解读时认为是关键时，能够提醒转诊提供者。虽然已经增加了记录的关键结果之间的沟通照顾者，有一个赤字，坚持建议的后续测试。特别是没有机制来监测和确保对具有关键成像结果的患者进行随访，这些结果需要在患者护理环境的过渡期间进行随访。有些关键的结果并不是突然出现的，但仍然是关键的和可操作的。这些被称为可操作的测试结果，并且包括所有关键成像结果的绝大多数。因此，我们计划设计和评估一个自动通知系统，该系统（1）识别住院和艾德患者在过渡到门诊护理时需要进行后续测试的关键成像结果，以及（2）用这些填充出院摘要后续测试建议。这将有助于沟通和记录后续测试建议，并评估这些建议是否得到及时执行。因此，拟议项目计划实现以下具体目标：（1）实施自动通知系统，用于（a）监测需要后续检查的关键成像结果，（B）将其记录在出院摘要中;以及（2）通过评估其对两个关键成像结果（肺结节和肾肿块）的建议后续程序的安排或完成的影响，对该自动系统进行评价。该项目将重点关注在住院和急诊科（艾德）环境中发现这些关键成像结果的患者。后续的随访检测建议预计将在门诊环境中完成。将在第1年上半年完成实施一个系统，监测关键成像结果的后续建议，并自动将其记录在出院总结中。为了评价通知系统，将与基线临床实践进行比较。BWH及其门诊设施每年进行超过500，000次成像程序，充分实施这一干预措施将通过确保通过出院模块将关键成像结果的随访测试传达给门诊环境中的主要护理人员，并记录在从艾德或住院环境过渡到门诊护理的患者的出院总结中，从而大大提高患者的安全性。此外，对整个系统的成功评价和示范将推动其他综合保健系统采取类似的办法，从而能够加强沟通和后续管理的业绩，不仅是对关键的成像结果，而且对所有关键的测试结果。

DESCRIPTION (provided by applicant): The Joint Commission has emphasized the need for improved communication of critical test results as a National Patient Safety Goal (NPSG). This goal includes subsequent implementation of follow-up procedures for managing critical test results. 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. This was facilitated by a notification system, partly funded by AHRQ, which enables alert notification of referring providers when results from imaging exams are deemed critical by a radiologist at the time of interpretation. Although there has been increase in documented communication of critical results between caregivers, there exists a deficit in adherence to recommended follow-up testing. There is especially no mechanism to monitor and ensure follow-up of patients who have critical imaging results that need to be followed across transitions in patient care settings. Some critical results are not emergent, but are nevertheless critical and actionable. These have been referred to as actionable test results and comprise a vast majority of all critical imaging results. We therefore plan to design and evaluate an automated notification system, which (1) recognizes critical imaging results that require follow-up testing for inpatient and ED patients when transitioning to ambulatory care, and (2) populate the discharge summary with these follow-up testing recommendations. This would enable communication and documentation of follow-up testing recommendations, and assess whether these recommendations are performed in a timely manner. The proposed project therefore plans the following specific aims: (1) Implement an automated notification system for (a) monitoring critical imaging results that require follow-up testing and (b) documenting them in the discharge summary; and (2) Evaluate this automated system by assessing its impact on scheduling or completion of recommended follow-up procedures for two critical imaging findings - pulmonary nodules and renal mass. The project will focus on patients that had these critical imaging findings discovered in inpatient and emergency department (ED) settings. Subsequent follow-up testing recommendations are expected to be completed in an ambulatory setting. Implementing a system that monitors follow-up recommendations of critical imaging results and automatically documenting them in the discharge summary will be completed during the first half of Year 1. In order to evaluate the notification system, a comparison will be conducted with baseline clinical practice. With over 500,000 imaging procedures performed at the BWH and its outpatient facilities annually, fully implementing this intervention would greatly promote patient safety by ensuring that follow-up testing of critical imaging results are communicated to primary caregivers in the ambulatory setting through the hospital discharge module, and documented in the discharge summary of patients who transitions from ED or inpatient settings to ambulatory care. In addition, a successful evaluation and demonstration of the overall system will provide an impetus for other integrated health systems to implement a similar approach that will enable enhanced communication and performance of follow-up management, not solely for critical imaging results but for all critical test results.