April 2012 Communication Issues The Joint Commission, ACR and Plaintiff’s Attorneys: New Rules, Standards and Legal Precedents Mandating Critical Test Result Management in Radiology Richard M. Chesbrough, M.D. President, Radiology Medical Consultants, P.C. Founder, RADAR Medical Systems, LLC
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Richard M. Chesbrough, M.D. President, Radiology Medical Consultants, P.C.
The Joint Commission, ACR and Plaintiff ’ s Attorneys: New Rules, Standards and Legal Precedents Mandating Critical Test Result Management in Radiology. Richard M. Chesbrough, M.D. President, Radiology Medical Consultants, P.C. Founder, RADAR Medical Systems, LLC. Sign of the times…. - PowerPoint PPT Presentation
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April 2012 Communication Issues
The Joint Commission, ACR and Plaintiff’s Attorneys: New Rules, Standards and Legal
Precedents Mandating Critical Test Result Management in Radiology
Richard M. Chesbrough, M.D.
President, Radiology Medical Consultants, P.C.
Founder, RADAR Medical Systems, LLC
April 2012 Communication Issues
Sign of the times…
April 2012 Communication Issues
Legal Facts
“Malpractice litigation alleging radiologic miscommunication is growing at a faster rate that any other type of radiologic wrongdoing.”
Berlin, Diagnostic Imaging, Nov. 2007; 31
April 2012 Communication Issues
Legal Facts
“25% of ACR members report being involved in at least one malpractice claim involving failure to communicate…”
Kushner, JACR 2005;2(1):15-21
Average payment…$1.9 Million Dollars.” Berlin L., Imaging Economics;
Sept, 2005
April 2012 Communication Issues
New ‘buzzword” in healthcare
Critical Test Result Management
“CTRM”
April 2012 Communication Issues
The Paradox of Radiology
Most advanced imaging technology and computer skills in the world.
Yet…still rely on “primitive” phone calls, answering machines, faxes and loose pieces of paper for communication of critical results.
* “One-way” communication.
* Often no permanent documentation
April 2012 Communication Issues
Radiology: We know things that others don’t….
April 2012 Communication Issues
Significant Findings: How would you handle this?57 yr old Outpatient: History: “cough”
What about unexpected findings: “Incidentalomas?”CT ABD: ER Patient: “R/O Appendicitis” Saturday 10:30 P.M.Study “negative” for appendicitis. LLL nodule noted. Patient discharged home (2:30 AM)
Lung Nodule
April 2012 Communication Issues
Retained SpongeAbdominal X-Ray: “abd. pain”
Retained Sponge
April 2012 Communication Issues
The Problem: No policies ?
The referring physician is not directly contacted on urgent or significant findings in up to 60% of cases. PIAA-ACR Study, 1997
Almost 20% of radiology departments do not have an established policy to communicate findings. PIAA-ACR 1997
85% of radiology malpractice suits are related to issues of communication. Berlin; Imaging Economics, Sept. 2005
April 2012 Communication Issues
The Problem: Referring Doctors ?
Referring Doctors and Radiologist’s advice: U. of Maryland Study
Court: “Because of the serious implications… “personal contact” was required to insure prompt action.”
April 2012 Communication Issues
Legal Precedent
Phillips v. Good Samaritan Hospital
416 NE 2d 646 (OH APP 1979)
“Radiologists who provide indirect medical care cannot escape liability by doing no more than relaying information through ordinary hospital channels.”
“The communication of the diagnosis… may be altogether as important as the diagnosis itself.”
Court: “When a patient is in peril… it does him little good if the [radiologist] has discovered his condition, unless the [radiologist]…informs the patient, or those responsible for his care...”
April 2012 Communication Issues
Legal Precedent * the future ?
Stanley v. McCarver92 P3d 849 (Ariz 2004)
Pre-employment CXR Radiologist: “possible lung cancer” Report sent to Employer (nursing home)
Patient not informed. (Dx’d CANCER -10 months later)
Patient expires Radiologist and nursing home sued Nursing home declares bankruptcy
April 2012 Communication Issues
Legal Precedent
Stanley v. McCarver (cont.) Trial Court:
Dismissed case against radiologist. Plaintiff appealed
Appellate Court : “If there is no referring physician, or the referring physician is unavailable, the duty to inform the patient shifts to the radiologist.” [italics added]
Arizona Supreme Court :Duty to inform is up to jury; case-by-case basis.
April 2012 Communication Issues
Joint Commission:
Joint Commission on Accreditation of Healthcare Organizations (Now – Joint Commission)
National Patient Safety Goals
No. 2: “Improve Effectiveness of Communication Among Caregivers.” 2A. Critical Test Results 2C. Measure Performance
April 2012 Communication Issues
JC: Communication Focus
59% of hospitals were in compliance with the Joint Commission national patient safety goal #2 in 2008
64% were compliant in 2007
….Problem not going away…
April 2012 Communication Issues
ACR Standards: American College of Radiology: Standards of Practice: 2008
“Significant Unexpected Findings: “[Radiologist must] “…communicate the findings to the referring physician… in a manner that reasonably insures receipt of the findings.”
(Requires “Direct communication”) In Person By Telephone
“In radiology…[traditional reporting] or putting the report into the RIS or EMR is inadequate.”
Chang P, Diagnostic Imaging, Oct. 2007; 40
April 2012 Communication Issues
New Alternatives:
American College of RadiologyStandards of Practice, effective Oct. 1, 2005 Communication of Findings, Section 5C:
New communications authorized: “Other forms of [reporting] that provide documentation of receipt…to
demonstrate that the communication has been delivered and acknowledged.”