In this session, radiology fellow Dr. Charles McGraw will describe how radiologists at the University of California, Los Angeles (UCLA) Health System have modified a software program to meet the needs of physicians at this multihospital enterprise and academic medical center.
The radiology department implemented a CTRM system in 2007. The application is launched from the speech recognition software with a single button click, which activates a window that enables a user to define who will receive the notification and categorize the notification by urgency level.
UCLA has defined three levels of urgency: red for results that need immediate attention, orange for results that need attention soon (e.g., a fracture or pneumonia), and yellow for results that a physician must acknowledge but do not have a critical time urgency associated with them. When not acknowledged, urgency levels are escalated in 15 minutes, 60 minutes, and five hours, respectively. The radiologists' paging staff then steps in.
Co-investigator Dr. Edward Zaragoza, a clinical professor and the section chief of acute care imaging and UCLA's radiology IT clinical director, told AuntMinnie.com that the department rapidly realized that the software needed to be customized to the workflow of the hospital.
"We asked recipients of critical test results how they wanted to be notified -- what would be most appropriate for their workflow," he said. "For example, emergency department physicians don't carry pagers. They want to receive information they can absorb in a glance. We do this by having the CTRM system page the emergency department clinical support staff to say they are being sent a critical test result from radiology, which is then transmitted by fax. Paper notification is preferred by the ER department because it can be handed to the person treating the patient."
For inpatients, notifying the team caring for a patient is most effective. A hospitalist, resident, or fellow may order an exam, but that person may not be on duty to receive the critical results notification and take action in a timely manner. When a new electronic medical record system is installed, it will be able to identify all members on a shift caring for a patient and also the person assigned to the group's service pager.
"We will be making the system a patient-centric versus physician-centric system," Zaragoza explained. "This is one of the 'lessons learned' that we will be talking about."