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

描述（由申请人提供）：联合委员会强调了作为国家患者安全目标（NPSG）改善关键试验结果沟通的必要性。这个目标包括管理关键测试结果的后续实施。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。这得益于由AHRQ部分资助的通知系统，当放射科医生在解释时认为影像学检查结果至关重要时，该系统可以向转诊提供者发出警报通知。尽管护理人员之间关于关键结果的书面交流有所增加，但在坚持推荐的后续测试方面存在缺陷。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，这些患者需要在患者护理环境的各个过渡阶段进行随访。一些关键的结果不是紧急的，但仍然是关键和可操作的。这些被称为可操作的测试结果，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)识别住院和急诊科患者在转到门诊护理时需要随访检查的关键成像结果，以及(2)在出院总结中填充这些随访检查建议。这将使后续测试建议的沟通和文档化成为可能，并评估这些建议是否得到及时执行。因此，拟议的项目计划以下具体目标：(1)实施自动通知系统，用于(a)监测需要后续测试的关键成像结果，以及(b)将其记录在出院摘要中；(2)通过评估该自动化系统对两个关键影像学发现（肺结节和肾肿块）推荐随访程序的安排或完成情况的影响来评估该系统。该项目将重点关注在住院和急诊科（ED）环境中发现这些关键成像结果的患者。后续的后续检测建议预计将在门诊环境中完成。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摘要中，将在第一年上半年完成。为了评估通报系统，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50万次成像手术，全面实施这一干预措施将极大地促进患者安全，确保通过出院模块将关键成像结果的后续测试传达给门诊环境中的主要护理人员，并记录在从急诊科或住院环境转到门诊护理的患者的出院摘要中。此外，对整个系统的成功评价和示范将推动其他综合卫生系统实施类似的方法，不仅对关键的成像结果，而且对所有关键的检测结果，都能加强沟通和后续管理的绩效。

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.