Critical Communication

The benefits of an automated CTRM system

Pioneers in critical test findings defined a “critical value” as a result that suggested that the patient was in imminent danger unless appropriate therapy or treatment was initiated promptly. Because of these observations, the concept of defining critical values and systems for reporting critical results has been adopted by labs worldwide.

In the United States, laboratory accrediting agencies, such as the Joint Commission and the College of American Pathologists, have made critical value reporting part of their requirements for accreditation. As part of meeting this requirement, the Joint Commission places the responsibility for determining what constitutes critical tests, results, and values on each laboratory; these determinations should fulfill the care needs of the facility and its patient population.

The timely and accurate reporting of critical test values to clinicians is an important aspect of patient safety. Studies show that physicians act on 65 percent of the critical test results that are communicated to them, often making changes to therapy that can save patients’ lives. While most hospitals genuinely believe they have addressed poor communication problems, the reality often is very different. The typical process for delivering and managing critical test results is usually manual, inefficient, error-prone, and inconsistent across departments.

Technology and Automation

The widespread clinical communication problem that healthcare organizations face requires a proven, easy-to-implement, and cost-effective enterprise solution that serves the needs and interests of both patients and their caregivers. Therefore, the potential for technological solutions to automate critical value reporting is evident.

Nationally, hospitals have been converting their manual systems and processes to commercially available automated solutions since early 2000, when Vocada (a company that was acquired by Nuance in 2008) introduced one of the first automated Critical Test Reporting Management (CTRM) applications, Veriphy. Around this time, the Joint Commission encouraged the industry to consider and utilize automated critical test reporting solutions as part of the clinical environment workflow when they highlighted the use of CTRM in their video series, “Patient Safety on the Line: Using Technology to Aid Effective Communication Among Caregivers.”

CTRM In Action

With CTRM, hospital administrators and physicians set performance standards for communicating critical test results, monitoring performance, and acting promptly when problems or negative trends appear. The heart of the system is technology that ensures direct communication by automating documentation, tracking, and compliance with legal and professional standards. An automated system also ensures critical communications are consistently acted upon and recorded in a unified manner throughout the medical institution.  

In April 2008, using Veriphy, Virginia Commonwealth University Medical Center (VCU) in Richmond automated its communication process associated with how critical test results are handled once they are identified in the radiology department. At that time, VCU was able to add Veriphy to its information flow process without disrupting the workflow of their radiologists. This was accomplished while also meeting the information needs of the ordering clinicians.

The implementation of Nuance’s automated CTRM application allowed VCU to convert their workflow from a manual process to greater than 99 percent automated without the need for human intervention. 

A Valuable Tool

U.S. hospitals complete approximately 12 billion radiology, laboratory, and cardiology tests every year. Most are negative and don’t require follow-up by the referring clinician. However, anywhere from 1 percent to 5 percent of a hospital’s test volume is abnormal or critical. Hospitals have a legal, ethical, and moral obligation to ensure that these results are communicated to the responsible physician or patient care team – automated CTRM systems are now closing that loop.

Steven Defossez, MD, of Beverly Radiology Associates in Beverly, Mass., agrees that an automated CTRM solution has improved his practice.

“The value of having an effective, consistent way of communicating patient information between providers is essential for patient safety and provider productivity,” Defossez says. “CTRM has allowed us to automate an otherwise unstructured, time-intensive process; improve patient care; and reduce malpractice risk with its auditable trail of what happened, when. The ability to share Veriphy’s audit trail across multiple systems through the VIS product is an extension that will help more hospitals get on board with best practices in clinical communications.”

– Christopher Click is the product marketing manager of diagnostic imaging for Nuance Healthcare in Burlington, Mass. Direct questions and comments to editorial@rt-image.com.