1. Guidelines for Communication & Reporting
Dartmouth Hitchcock- Lebanon
2017

2. Manage Incidental Finding
Connect to Providers
Track Communication
Report Quality Issues
Manage Incidental Finding
Guidelines on:

3. DH Lebanon exams Outreach exams Use these guidelines
Some guidelines may not apply
Please check with outreach coordinators or Yvonne Cheung for details

4. Click on underline text to bring you to the section
1. Connect to providers
2. Communicate abnormal findings
3. A few useful auto texts
4. Report on quality issues
5. Manage Incidental findings

5. Easiest way to connect to provider
Use page or phone
Ask outreach coordinator to connect
Connect to provider
Easiest way to connect to provider

6. You are on your own during weekends
Outreach Coordinators
Available weekdays 8am – 9 pm

7. Reach Outreach Coordinators by phone, pager and email
Easiest by
communication
Pager
phone
5775
53852

8. Use email to connect to outreach coordinators – most efficient
First, Highlight demographics

9. Email task to outreach coordinator
Copy
(crtl C)

10. Email task to outreach coordinator
1. Paste demographics,
2. Request connect to provider &
3. Send to Radiology outreach 1 3 2

11. Please communicate findings that requires immediate communications with the providers, such as:
Conditions that are life threatening (e.g. tension pneumothorax)
Conditions that require immediate change of management (retained surgical objects)
Communicate Results

12. Document Communications
Use Autotext to document the communication
“communications”
“critical communications”
Please tag these reports by adding the term “critical results” in the report so we can track these.
Document Communications

13. Our department tracks and audits a few selected conditions (critical results) that require urgent communication, to satisfy the Joint Commissions requirements.
We audit whether documentation has occurred AND the time between completion of exam and communication
Audit communications

14. Tag Report by adding “Critical Results” in dictation
If any of these conditions are encountered in the exam, please tag the report by add the phrase ”critical results” after documenting the communication to the provider. This helps with the auditing process.
Let’s first take a look at Radiology Department’s classification.
Unexpected finding. Also, the Joint Commission is not following unexpected findings. As a result, it is not included in the later analysis; only critical tests and critical results are included.
Critical test requires response within time frame no matter if it is positive or negative
Critical result is the most dangerous situations and requires immediate reply
Aortic dissection is accounted for in both categories. These seven conditions were chosen by the Radiology Department five years ago.
The Radiology Department is doing well in taking care of patients. But for documentation requirements by the Joint Commission, the Radiology Department has some problems.

15. Selected conditions (critical results list) that we track and audit to ensure communications are timely (<60 minutes) and documented.
Critical Results
Modality
Acute Paralysis CT
Retained Surgical Foreign Body
XR, CT
Acute aortic dissection or injury
Acute aortic aneurysm rupture
Active intra-abdominal hemorrhage
Large and/or Central Pulmonary Embolism
Unexpected free air in the abdomen
Tension Pneumothorax
CT, XR
Retained surgical foreign body   XR
Misplacement of tubes or catheter (if not previously reported )
Ectopic pregnancy US
Testicular/Ovarian Torsion 
Spine fractures that are acute and or might be unknown to the requesting provider
Let’s first take a look at Radiology Department’s classification.
Unexpected finding. Also, the Joint Commission is not following unexpected findings. As a result, it is not included in the later analysis; only critical tests and critical results are included.
Critical test requires response within time frame no matter if it is positive or negative
Critical result is the most dangerous situations and requires immediate reply
Aortic dissection is accounted for in both categories. These seven conditions were chosen by the Radiology Department five years ago.
The Radiology Department is doing well in taking care of patients. But for documentation requirements by the Joint Commission, the Radiology Department has some problems.

16. on the desktop This list can be found
List of Conditions that DH audits for Communication with Provider
This list can be found
on the desktop
on the Departmental website.

17. i.e. findings that require urgent communication
Reports with the following conditions are tracked & audited for documented communication
please communicate all other conditions that you consider important for patient care.
This list represents a tiny number of conditions that merits direct communication.
The list is purposely kept short to simplify tracking.
The list is the following slide.
Critical results
i.e. findings that require urgent communication
Let’s first take a look at Radiology Department’s classification.
Unexpected finding. Also, the Joint Commission is not following unexpected findings. As a result, it is not included in the later analysis; only critical tests and critical results are included.
Critical test requires response within time frame no matter if it is positive or negative
Critical result is the most dangerous situations and requires immediate reply
Aortic dissection is accounted for in both categories. These seven conditions were chosen by the Radiology Department five years ago.
The Radiology Department is doing well in taking care of patients. But for documentation requirements by the Joint Commission, the Radiology Department has some problems.

18. Too many list to remember

19. Forget the list, just call and document call

20. Unexpected finding e.g. incidental lung nodule on pre-op cxr
Unexpected findings are conditions that could result in significant morbidity if not appropriately treated but are not immediately life threatening.
e.g. incidental lung nodule on pre-op cxr
Let’s first take a look at Radiology Department’s classification.
Unexpected finding. Also, the Joint Commission is not following unexpected findings. As a result, it is not included in the later analysis; only critical tests and critical results are included.
Critical test requires response within time frame no matter if it is positive or negative
Critical result is the most dangerous situations and requires immediate reply
Aortic dissection is accounted for in both categories. These seven conditions were chosen by the Radiology Department five years ago.
The Radiology Department is doing well in taking care of patients. But for documentation requirements by the Joint Commission, the Radiology Department has some problems.

21. Unexpected finding communication
Our team of administrative assistants will do all the communication and documentation.
Radiologist tags report as
“unexpected finding”.
Let’s first take a look at Radiology Department’s classification.
Unexpected finding. Also, the Joint Commission is not following unexpected findings. As a result, it is not included in the later analysis; only critical tests and critical results are included.
Critical test requires response within time frame no matter if it is positive or negative
Critical result is the most dangerous situations and requires immediate reply
Aortic dissection is accounted for in both categories. These seven conditions were chosen by the Radiology Department five years ago.
The Radiology Department is doing well in taking care of patients. But for documentation requirements by the Joint Commission, the Radiology Department has some problems.

22. Useful Autotext – in powerscribe
“Communication”- I, Dictator Name, discussed these results, Results, with Referring Name on Current Date and verified that (s)he understood these results.
“Critical Communication”- I, Dictator Name, discussed the Critical Result or Test with Referring Name on Current Date and verified that (s)he understood these results.
“Change in interpretation” - This represents a change from the Report: draft/preliminary report.  These changes were discussed with Physician by Radiologist on Date at Time.
Useful Autotext – in powerscribe

23. Inappropriate history on requests
Technical issues
e.g. poor quality image
Inappropriate history on requests
e.g. chest pain as indication for a foot xr
Reporting of Quality Related Issues

24. Report suboptimal imaging techniques
Highlight demographics

25. Copy demographics
Copy
(crtl C)

26. 3 1 2 Send to RadiologyQI 1. Paste demographics,
2. State problem in Subject line
3. Send to RadiologyQI 1 3 2

27. Report inappropriate history
1. Paste demographics,
2. Subject line : missing or inappropriate history
3. Send to Radiology Outreach
4. Our outreach coordinator will fill out an OWLS for you

28. Uploaded in Geisel Radiology website Or link on all desk tops
e.g. adrenal nodules
Manage Incidental Findings
Use ACR white papers
Uploaded in Geisel Radiology website
Or link on all desk tops

29. Manage Incidental finding
ACR references on incidental findings available at:
Geisel Radiology site in the education section
2. Link on desk top

30. Manage Incidental Finding

32. pleases contact Yvonne Cheung for more questions. email: yvonne
pleases contact Yvonne Cheung for more questions. or ask outreach coordinator to find me