Transcript File - College Of Imaging Administrators

The Big Problem with
Diagnostic Test Results
Brian Gale, MD
5/5/2016
Disclosures
• Managing Member, SaferMD, LLC
An Infection, Unnoticed, Turns Unstoppable
Rory Staunton taking his first flying lesson in 2011.
By JIM DWYER
Published: July 11, 2012
Malignant Melanoma
• Test results are the ultimate Radiology work
product
The Problem
• Who’s the next Rory Staunton?
• LAB+ PATH+CARD=Rad vol.x10
• Communications failure consequences:
• Delayed care (Morbidity), mortality
• “Sentinel event” requires report to state
• Reputational risk
• Liability risk
• Who is the most concerned about this situation?
Risk of the Unexpected
RSNA 2015 . Michael Raskin, MD, MPH, JD: “In failure to communicate, it’s ….
more of the unexpected findings. For example… a lung tumor seen on a
shoulder X-ray…
“Sometimes it requires a direct communication, or what we call nonroutine
[communication].”
To safeguard against malpractice, Raskin recommends closed loop
communication, similar to what the airline industry uses.
“You not only tell them the information,” he said. “You make sure that they
understand what you’ve said.”
Hazar, Liza. Diag Imaging. 2016 April 11. http://bit.ly/1Zd7ht1
AJR:206, March, 2016
Methods Inf Med 2010; 37-43.
Communication Failures Cost
$4.8 Billion in 2011 1
• Increasing proportion of US malpractice awards
• Statistically significant trend
• Risk affects all specialties (both diagnostic and
referring physicians) and facilities
1Gale
B, et. al.. Failure to communicate reportable test results. Journal of the American
College of Radiology 2011. 8:776-779.
FTC % of Malpractice Awards
FTC Cost in 2015
• CRICO-RMF report: 30% of paid claims
• $6 billion awarded for test result communication
failure
• Malpractice underwriters: $6 billion (personal
communication)
The Value of Standards
http://www.collectorsweekly.com/articles/let-there-be-light-bulbs/
Obsolete light bulbs, circa 1904
http://www.collectorsweekly.com/articles/let-there-be-light-bulbs/
Non-Technical Solutions
•Clinical History
•Indications
•Exam
• Quality
• Data
• Findings
Afferent and Efferent
Communications
•Report
•Structure
•Actionable Findings
•Notification
Goal of Imaging 3.0
• Counter the threats to our profession by
promoting practice patterns that increase
radiologists relevance
• Radiologists have become removed from hands-on
patient care.
• To stay relevant, radiologists must become
involved and communicate with referring
physicians, patients and politicians
• Communication is key
5 Components of Effective
Communication
The 5 “C”s
• Complete
• Clear
• Concise
• Correct
• Concrete
Margaret S. H. Taghavi, MD, Brian D. Gale, MD, MBA, Paul Nagy, PhD, Cindy S.
Lee, MD. The Radiology Communication Quiz:Are You an Effective
Communicator? JACR. 12:10. 2015. October.
Complete Communication
• Convey all relevant facts to the receiver, taking
into consideration
• WHO the receiver is (physician versus patient)
• What is RELEVANT to him/her (surgeon versus
internist)
• Complete communication has the following
features:
• No crucial information is missing
• Always give additional information when required
• Leave no questions in the mind of the receiver
• Complete communication helps in better decision
making by the receiver of the message
Concise Communication
• Communicate what you want to convey in the
least possible words without forgoing the other
C’s of communication
• Concise communication has the following
features:
• Highlights the main message as it avoids using
excessive and needless words
• Convey a short and essential message in limited words
• A concise message is more appealing and
comprehensible to the receiver
Concrete Communication
• Concrete communication implies being
particular and clear rather than fuzzy and
general
• Concrete message has following features:
• Use words that are clear
• Supported with specific facts and features
• Concrete messages are not misinterpreted
Clarity
• Make the complex simple
• Organize and prioritize thoughts in your mind
before you attempt to communicate your ideas
• Emphasize a specific message rather than trying
to achieve too much at once
• Clarity in communication has the following
features:
• Makes understanding easier
• A clear message makes use of exact, appropriate and
concrete words
• Because radiologists are consultants, we must be
able to communicate findings to referring
physicians and patients as clearly as possible
Correctness
• Correct communication has the following
features:
• Message is exact, correct and well-timed
• It makes use of appropriate and correct language in
the message
• No grammatical errors
Facilitate Test Result Communication
Benefits
• Patient Safety
• Decreased LOS
• Fewer unreimbursed re-admissions
False Claims Act
Financial Consequences
• CMS Compliance
•
False Claims Act
•
HEAT
•
Quality of Care Standard
Revenue and Costs
• PQRS + MU = MIPS + MACRA
• New measures of communications activity
• Malpractice Risk Management Credits
•
Conflict of Interest
•
Communications audits
Measure #
Measure
1
Critical test: OR Foreign Body
2
Critical test: Stroke
3
4
Critical test: Intracranial
Hemmorhage
Critical test: Aortic Dissection
5
Critical Test Protocol
6
Critical Result: Pulmonary
Embolism
Critical Result: ICH
Critical Result: Aortic
Dissection
Critical Result: Occlusive
intracranial stroke
7
8
9
NQS Domain
Communication and Care
Coordination
Communication and Care
Coordination
Communication and Care
Coordination
Communication and Care
Coordination
Communication and Care
Coordination
Patient Safety
Type
Outcome
Patient Safety
Patient Safety
Process
Process
Patient Safety
Process
Outcome
Outcome
Outcome
Process
Process
Measure #
10
11
12
13
14
15
16
17
18
Measure
Critical Result: Placental
abruption
Critical Result: Ruptured
ectopic pregnancy
Critical Result: New DVT
Critical Result: Eptopic
Pregnancy
Critical Result Protocol
Urgent Result Protocol
Unexpected Result Protocal
Result Requiring Follow Up
Protocol
Follow Up Exam Obtained
NQS Domain
Patient Safety
Type
Process
Patient Safety
Process
Patient Safety
Patient Safety
Process
Process
Patient Safety
Patient Safety
Patient Safety
Effective Clinical Care
Process
Process
Process
Process
Effective Clinical Care
Process
Test Result Notifications
Auditing
• Continuous test result notification activity
• Provider management tool.
• Works in background; doesn't hinder workflow
• Benchmark providers’ performance
• Malpractice Insurance risk management credits
Patient Safety Work Product
• Paraphrasing James Harriman: Measurement
leads to improvement
• Patient Safety Organization protection