Practice Patterns in Reporting Critical Findings: A Survey of Vascular Ultrasound Facilities

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Introduction/Patient Description

Vascular laboratories provide professional medical imaging and identify findings of a critical nature requiring urgent management. Accrediting bodies and various guidelines advise each facility establish mechanisms for conveying critical findings (CF). Specific aims address protocols/routine CF reporting strategies and varied approaches/handling of ‘breakdown’ in CF reporting.

Methods

Literature review was done to define CF and inform an online survey. Survey was beta-tested and distributed to vascular ultrasound (VUS) experts in North America. Results were compiled to assess the status of the handling of CF in VUS facilities. Quantitative data and full text responses were categorized into basic thematic constructs for analysis.

Results

Survey elicited 81 responses. 94% accredited labs. Dataset themes focus on practical issues of how CF are conveyed to medical personnel: Responses vary in method, 34% prefer using classic chain of medical responsibility method, 11% depend on timely report generation, 17% specify no issue in their lab and 5% deploy a case-by-case system. Only 5% of responses explicitly require a patient with VUS CF to be “held” pending medical care. “New/acute” CF tend to elicit unique justifications for distinct or one-off reporting protocols/notification methodologies. Survey data documented 55 separate instances regarding importance of “new/acute” CF in free-text answer options. 69% use variable protocols when asked how “a break in the CF process” is handled.

Conclusion/Discussion

Study highlights importance of appropriate handling of VUS CF. Notwithstanding published ‘requirements’ and facilities possessing protocol strategies, frequent modifications occur. New/acute findings often elicit one-off approaches. Breaks in protocol lead to unconventional notification solutions. Results of study can inform improved protocols and requirements in practice.

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Presented by

David Williams, Technical Director, MUSC Health Florence Cardiovascular Surgery