Attachment 6 - ORL RAD SOP Critical Results and Critical Tests for Teleradiology.pdf

VA Healthcare System Radiology Service SOP

Orlando, FL March 2021

Critical Results and Critical Tests SOP

1. PURPOSE: Critical tests are time-sensitive imaging examinations which may require priority review and reporting by the radiologist. Critical results are findings on an imaging examination, as interpreted by the radiologist of record, which could result in mortality or significant morbidity if urgent or semi-urgent follow up steps are not taken.

2. STANDARD OPERATING PROCEDURE (SOP): This SOP of the Imaging Service defines which tests are considered “Critical Tests,” which results are considered “Critical Results, and the actions required by the radiologist pertaining to critical test and critical results.

3. ACTION: All Radiology employees are responsible for following the procedures and guidelines outlined below.

4. PROCEDURE:

a. The list of Critical Results are as follows:

i. Tension pneumothorax

ii. Ruptured aortic aneurysm

iii. Unexpected free air in the abdomen

iv. Acute intracerebral hemorrhage

v. Acute cord compression

vi. Unstable fractures that might be unknown to the requesting provider

vii. Evidence of ischemic bowel

viii. Significant pulmonary embolism

ix. Acute lower extremity deep venous thrombosis

x. Ovarian or testicular torsion

xi. Ectopic pregnancy

b. The list of Critical Tests are as follows:

i. Intra-operative radiograph to evaluate for possible retained foreign body after instrument count discrepancy.

ii. Acute stroke protocol CT of the brain.

c. When a case review reveals a Critical Result the radiologist must take the following actions:

i. Report finding in the radiology report.

ii. Set the alert code in the radiology report to 1002

iii. Report the finding directly by telephone to the ordering practitioner or surrogate practitioner.

1. Report must be made by telephone or face-to-face contact.

2. Reporting must be made within 60 minutes.

3. Support staff can be utilized to facilitate efforts to establish radiologist to facility ordering practitioner or surrogate practitioner communication.

4. First effort should be to contact the ordering practitioner or surrogate practitioner.

a. If the ordering practitioner or surrogate practitioner is not directly reachable by telephone, the clinical contact designated by the facility will be called.

i. The designation is listed in the Medical Center Critical Results Policy.

iv. Documentation within the radiology report (or addendum) must be made to indicate who was informed at the local facility and when that person was informed.

1. The critical results documentation should include the individual who communicated the critical results, the individual who received the critical results, the mode of communication, and the date and time of the communication. For example:

a. [Critical Results/Critical Exam findings] [was/were] communicated [by me] to [Dr/NP/PA Name] [via telephone/in person] at [HH:MM AM/PM] on [MM/DD/YY].

d. When case meets the definition of a Critical Test, the radiologist must take the following actions:

i. If the case is a STAT intra-operative radiograph to evaluate for possible retained foreign body after instrument count discrepancy, the findings must be reported (regardless of the results) directly by the radiologist to a member of the surgical team (nurse, surgeon or anesthesia provider).

1. Report must be made by telephone or face-to-face contact.

2. Report must be made within 30 minutes of obtaining the image.

ii. Documentation within the radiology report (or addendum) must be made to indicate:

1. The individual who was informed at the local facility.

2. The time when that person was informed.

5. REFERENCES: VA Online Radiology Guide

John F. Hoy, MD Chief, Radiology Service