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，作为国家患者安全目标(NPSG)，需要改善关键测试结果的沟通。这一目标包括后续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全企业范围的政策，作为三年质量改进倡议的一部分，以加强关键成像结果的沟通。这是由AHRQ部分资助的通知系统促进的，该系统允许在影像检查结果被放射科医生在解释时认为关键时向转诊提供者发出警报通知。尽管照顾者之间关于关键结果的书面交流有所增加，但在遵守建议的后续测试方面存在不足。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的随访，这些患者需要在患者护理环境中的过渡期间进行跟踪。一些关键结果不是紧急的，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，并且包含了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种自动通知系统，该系统(1)识别在过渡到门诊护理时需要对住院患者和ED患者进行后续测试的关键成像结果，以及(2)使用这些后续测试建议填写出院摘要。这将使后续测试建议得以沟通和记录，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)实施一个自动通知系统，以便(A)监测需要进行后续检查的关键成像结果，并(B)将其记录在出院总结中；(2)通过评估这一自动化系统对安排或完成建议的两个关键成像发现--肺结节和肾脏肿块--后续程序的影响，对该系统进行评价。该项目将专注于在住院和急诊科(ED)环境中发现这些关键成像结果的患者。后续的后续测试建议预计将在门诊环境中完成。实施监测关键成像结果的后续建议并将其自动记录在出院总结中的系统将在第一年上半年完成。为了评估通知系统，将与基线临床实践进行比较。由于每年在BWH及其门诊设施进行的成像手术超过500,000例，全面实施这一干预措施将确保关键成像结果的后续测试通过医院出院模块传达给门诊环境中的主要护理人员，并记录在从急诊或住院环境过渡到门诊护理的患者的出院摘要中，从而极大地提高患者的安全。此外，对整个系统的成功评价和演示将推动其他综合保健系统采用类似的办法，加强后续管理的沟通和绩效，不仅是针对关键成像结果，而且是针对所有关键测试结果。

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.