David Hirschorn

IT Matters – Critical test result management

September 03, 2015
by Sean Ruck, Contributing Editor
When people use the phrase “a matter of life or death,” it’s often hyperbole.
Of course, for medical professionals dealing with critically ill patients, there’s less exaggeration. When a patient has serious indications and tests are ordered, making sure the results are delivered to the right doctor at the right time and even in the right format or way, can make all the difference.

To get an idea of how the process flows when it’s being carried out successfully, HealthCare Business News spoke with Dr. David Hirschorn. Hirschorn, the director of radiology informatics at Staten Island University Hospital, is well-acquainted with the technology and steps to take in order to successfully manage critical test results.

Much of the challenge as Hirschorn sees it is to make sure the staff involved understand and follow procedure. Just like other hospital-based activities, if one individual doesn’t stick with the game plan, the result can be a cascade of problems. Hirschorn offers an example: “Radiologists have a case to read and they come to a point that requires communication. There are some things that require routine communications and acknowledgement of the message,” he says. “If you see a chest X-ray where a patient is in trouble and the physician needs to know about it right away, just writing a report won’t do it.”

Hirschorn says that the notification needs to escalate and it needs to clearly be identified as an urgency communiqué. Following procedure (which may differ from facility to facility), maybe a phone call or a page will be made and then the doctor caring for the patient will be informed. The doctor might also be tracked down for a face-to-face briefing.

“If you see a feeding tube in the lung instead of the stomach or you see a patient lung collapsed — and maybe no one else realizes because their oxygen saturation is still good and their lungs are working fine,” those are two situations that need immediate attention, says Hirschorn. Those types of problems are fairly common, but they can still cause serious harm or death if not handled promptly. “It requires the right person at the right time to get the message in the right way,” says Hirschorn.

It’s not enough or OK just to have the secretary at the doctor’s office receive the message. They’re not legally required to get the message to where it needs to go next, says Hirschorn. Ultimately, the message needs to get to a certified health care provider, either a doctor or a nurse practitioner, for example. “Therein lies the biggest challenge — if radiologists knew they could pick up ‘the Bat Phone’ and they could immediately get the physician they needed, they’d be thrilled. But that’s not reality. First thing you need to find out is who the contact is, and second, how to reach them,” says Hirschorn.

So, how do you handle this? You might say, the easiest way to figure this out is to look at who ordered the test and get the results back to them. But Hirschorn cautions against that approach.
“Frequently, for valid reasons, that’s not possible. Take the outpatient setting for example. What if the doctor is on vacation or maybe in the OR? Or some other perfectly valid reason they’re unavailable. So there has to be someone covering for the doctor.”

That someone, as previously noted, has to hold a medical certification, but after that requirement is met, the field opens up. If a physician’s assistant is one of the links in the process chain, he or she can receive the message and then use the appropriate means of escalation. “In the inpatient setting — it’s a different problem,” says Hirschorn. “Maybe the doctor went off-shift and the doctor in the next shift is taking care of the patient now.”

It’s up to the hospital and the teams to determine who will be in charge. Some hospitals have computer systems in place to see who’s taking care of which patients, but that’s not to be confused with who the patient is actually assigned to.

“I’ve almost never met a nurse who, if you ask them who the doctor is taking care of the patient, they couldn’t tell you. Or if they weren’t familiar, they’d get it figured out.” Once the nurses get it figured out, the doctor still needs the heads-up. And that’s where technology helps again.

Once the doctor is identified, there are systems out there that try to deliver the message. They’ll take a message either by voice or text, and then try to page or alert the doctor currently taking care of the patient. So if the doctor you think is taking care of the patient doesn’t respond in a given time frame, the notification process escalates. Some places have success with the automated systems. In other facilities, physicians rejected the machine-based system, often because they claimed it had difficulty identifying the right person to communicate with. There are some places that deliver the message to a cell phone app.

“I created a system that serves as a work list for the clerks in our radiology department. It gives urgent versus important — don’t need to call them out of bed to answer, but they need to know about it,” says Hirschorn.