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.