Unscheduled Radiologic Examination Orders in the Electronic Health Record: A Novel Resource for Targeting Ambulatory Diagnostic Errors in Radiology

Lacson, Ronilda; Healey, Michael; Cochón, Laila; Laroya, Romeo; Hentel, Keith; Landman, Adam B.; Eappen, Sunil; Boland, Giles W.; Khorasani, Ramin

doi:10.1016/j.jacr.2019.12.021

Cited by 7 publications

(3 citation statements)

References 40 publications

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Order By: Relevance

“…As an example of a safety event, we described a delayed ultrasound that led to a delayed diagnosis of lymphoma in our institution. The ordered exam was unscheduled for months, and we have demonstrated that 7% of our diagnostic imaging orders remain unscheduled 21 . Most orders remained clinically necessary.…”

Section: Discussionmentioning

confidence: 91%

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Collaborative Case Review: A Systems-Based Approach to Patient Safety Event Investigation and Analysis

Lacson

Khorasani

Fiumara³

et al. 2021

J Patient Saf

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ObjectivesThe aims of the study were to assess a system-based approach to event investigation and analysis—collaborative case reviews (CCRs)—and to measure impact of clinical specialty on strength of action items prescribed.MethodsA fully integrated CCR process, co-led by radiology and an institutional patient safety program, was implemented on November 1, 2017, at our large academic medical center for evaluating adverse events involving radiology. Quality and safety teams performed reviews for events identified with other departments who maintained their existing processes. This institutional review board–approved study describes the program, including percentage of CCR from an institutional Electronic Safety Reporting System, percentage of CCR per specialty, and action item completion rates and strength (e.g., stronger) based on a Veterans Administration–designed hierarchy. χ2 analysis assessed impact of clinical specialty on strength of action prescribed.ResultsSeventy-three CCR in 2018 generated 260 action items from 10 specialties. Seventy percent (51/73) were adverse events identified through Electronic Safety Reporting System. The specialty most frequently associated with CCR was radiology (16/73, 22%). Most action items (204/260, 78%) were completed in 1 year; stronger action items were completed in 71 (27%) of 260. Radiology was responsible for 61 action items; 25 (41%) of 61 were strong versus all other specialties with strong action items in 46 (23%) of 199 (P < 0.01).ConclusionsAn integrated multispecialty CCR co-led by the radiology department and an institutional patient safety program was associated with a higher proportion of CCR, stronger action items, and higher action item completion rate versus other hospital departments. Active engagement in CCR can provide insights into addressing adverse events and promote patient safety.

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Section: Discussionmentioning

confidence: 91%

“…The ordered exam was unscheduled for months, and we have demonstrated that 7% of our diagnostic imaging orders remain unscheduled. 21 Most orders remained clinically necessary. This could be a large contributor to delay in diagnosis, an important patient safety concern.…”

Section: Discussionmentioning

confidence: 99%

Collaborative Case Review: A Systems-Based Approach to Patient Safety Event Investigation and Analysis

Lacson

Khorasani

Fiumara³

et al. 2021

J Patient Saf

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“…Each department created a paradigm centered on clinical need, urgency, and resource availability to manage these studies as medical services gradually become available once more. We have prior experience in developing systems to assess clinical necessity and complete large numbers of unscheduled studies in radiology, 25 which serves as an institutional framework for addressing the current situation.…”

Section: What We Did and Lessons Learned: Promoting Safety In Virtual...mentioning

confidence: 99%

Ambulatory Virtual Care During a Pandemic: Patient Safety Considerations

Mullur¹,

Chen²,

Wickner³

et al. 2022

J Patient Saf

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BackgroundThe COVID-19 pandemic prompted sudden and fundamental changes in health care, including a rapid rise in the utilization of telehealth services in the ambulatory setting. With the unprecedented and significant decline in traditional office-based visits and procedures, novel patient safety risks and challenges emerged.MethodsThe ambulatory practices at our quaternary care, academic medical center experienced a 200-fold increase in virtual visit volume between February and April 2020. We convened a multidisciplinary working group dedicated to evaluating quality and safety when providing virtual visits during a pandemic. Our primary outcome was patient experience with virtual care delivery, which was assessed by leveraging patient complaint data and patient satisfaction survey data.ResultsFor our main focus of patient experience and satisfaction, survey data were analyzed from the approximately 76,616 virtual visit encounters that occurred between March 1, 2020, and April 21, 2020. During this period, 5 patient complaints were filed to the Patient Advocacy Department. Overall, patient satisfaction with telehealth remained stable and high at >93% from February to May 2020. As we assessed these data each month, our working group developed risk mitigation strategies in response to the novel challenges presented by the use of telemedicine due to the COVID-19 pandemic while working to maintain patient satisfaction with care. We identified quality and safety issues around patient factors including optimal triage of patients and use of technology. We also evaluated accessibility to virtual platforms and logistics such as coordination of care for diagnostic testing. Finally, a guidance document was created and communicated to our diverse ambulatory practices to support clinicians.ConclusionsAmbulatory virtual care delivery requires a dynamic, flexible model of care through continuous rapid-cycle process improvement to mitigate patient safety risks during a pandemic, incorporating both provider and patient perspectives.

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Fast and Frictionless: A Novel Approach to Radiology Appointment Scheduling Using a Mobile App and Recommendation Engine

et al. 2023

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Unscheduled Radiologic Examination Orders in the Electronic Health Record: A Novel Resource for Targeting Ambulatory Diagnostic Errors in Radiology

Cited by 7 publications

References 40 publications

Collaborative Case Review: A Systems-Based Approach to Patient Safety Event Investigation and Analysis

Collaborative Case Review: A Systems-Based Approach to Patient Safety Event Investigation and Analysis

Ambulatory Virtual Care During a Pandemic: Patient Safety Considerations

Fast and Frictionless: A Novel Approach to Radiology Appointment Scheduling Using a Mobile App and Recommendation Engine

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