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85 Radiology report alerts! are email ‘fail-safe’ alerts acknowledged and acted upon?
  1. Christopher Watura,
  2. Sujal Desai
  1. Imaging Department, Royal Brompton Hospital, Sydney St, Chelsea, London


Background After identifying failure to act on radiology reports as a cause of patient safety incidents, The Royal College of Radiologists and National Patient Safety Agency released guidelines stipulating that it is incumbent on radiology departments to use ‘fail-safe alert’ systems to communicate critical and significant unexpected results. Electronic systems are preferred, to reduce errors, increase workflow efficiency and improve auditability. A paucity of evidence exists on the effectiveness of such systems.

Aim To assess i) acknowledgment of email radiology report alerts by clinical referrers and ii) where indicated, whether follow-up imaging was performed.

Methods and Materials A full-cycle audit conducted at a tertiary referral centre in London, which uses the email-based ‘RadAlert’ system (Rivendale Systems, UK). All cases on the RadAlert database between 5th February 2017 and 31 st July 2017 were audited in cycle 1 and, following departmental educational meetings, the first 100 cases during Sept 2017 in cycle 2. The target compliance for acknowledgment of alerts was 100%.

Results In cycle 1, 39% (154/390) alerts were ‘accepted’, 55% (213/390) ‘abandoned’, 5% (21/390) ‘declined’ and 1% (2/390) ‘cancelled’. In a sample of ‘abandoned’ alerts, follow-up imaging (where deemed indicated based on the report) was still performed for 76% (19/25).

In cycle 2, 56% (56/100) alerts were ‘accepted’, 37% (37/100) ‘abandoned’, 4% (4/100) a ‘duplicate record’ on the database and 3% (3/100) ‘declined’. Of all ‘abandoned’ alerts, follow-up imaging (where deemed indicated) was still performed for 76% (22/29).

Conclusion Acknowledgment of report alerts by referring clinicians may be increased through departmental educational meetings. Radiologists should not rely solely on email alerts however, since a considerable proportion continue to be unacknowledged by the recipient. Appropriate follow-up imaging was undertaken regardless in these cases, suggesting that radiologists continue to also rely on other alert methods despite the introduction of the email based system.

  • Radiology
  • Reporting
  • Alerts
  • Communication
  • Safety

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