Deployment of Enhanced Critical Imaging Result Notification (DECIRN)

描述(由申请人提供)：联合委员会强调，需要改善关键检测结果的沟通，作为其2010年国家患者安全目标之一。关键结果的沟通延迟会造成诊断延迟，最终导致管理延迟，从而对患者的安全构成重大威胁。在诊断成像中，目前还没有关于结果沟通的及时性、理想的沟通场所，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，作为三年质量改进倡议的一部分，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，用于在确定关键的成像结果时通知转诊医生。在一项试点研究中，关键结果完全符合这一政策的比例在三年内从28.6%增加到94.6%。然而，这项试点评价需要人工审查个别报告，因此在三年内只审查了12 193份报告(不到1%)。全面评估将为成功实施和通过这项政策提供更明确的信息。因此，拟议项目计划实现以下具体目标：(1)实施一项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和干预措施遗漏的关键结果的记录的影响，对这一干预措施进行评估；(3)开发一个广泛传播的实施工具包。将在项目开始之日开始实施CCTR政策，全面部署关键结果自动通知系统(ANCR)。为了评估增强型危重成像结果通知(DECIRN)的实施情况，我们将进行一项前瞻性的单交叉临床试验，将干预措施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60万例，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，将分发一个执行工具包，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，并在可能的情况下实现自动通知。 公共卫生相关性：关键结果沟通的延迟造成诊断延迟，最终导致管理延迟，从而对患者安全构成重大威胁。布里格姆妇女医院(BWH)制定了关键检测结果沟通(CCTR)政策，以加强关键成像结果的沟通。这项研究旨在使用关键结果自动化通知来加强这一政策的自动化实施，这是一个自动化的关键成像结果管理系统，以促进患者安全并鼓励广泛采用。

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.