Abstract
In the current digital and filmless age of radiology, rates of unread radiology exams remain low, however, may still exist in unique environments. Veterans Affairs (VA) health care systems may experience higher rates of unread exams due to coexistence of Veterans Health Information Systems and Technology Architecture (VistA) imaging and commercial picture archiving and communication systems (PACS). The purpose of this patient safety initiative was to identify any unread exams and causes leading to unread exams. Following approval by departmental quality assurance committee, a comprehensive review was performed of all radiology exams within VistA imaging from July 1, 2009 to June 30, 2014 to identify unread radiology exams. Over the 5-year period, the total unread exam rate was calculated to be 0.17%, with the highest yearly unread exam rate of 0.25%. The leading majority of unread exam type was plain radiographs. Analysis revealed unfinished dictations, unassociated accession numbers, technologist errors, and inefficient radiologist work lists as top contributors to unread exams. Once unread radiology exams were discovered and the causes identified, valuable process changes were implemented within our department to ensure simultaneous tracking of all unread exams in VistA imaging as well as the commercial PACS.
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Abbreviations
- CT:
-
Computed tomography
- VA:
-
Veterans Affairs
- PACS:
-
Picture archiving and communication system
- RCA:
-
Root cause analysis
- ACR:
-
American college of radiology
- VistA:
-
Veterans Health Information Systems and Technology Architecture
- IT:
-
Information technology
- HIPAA:
-
Health Insurance Portability and Accountability Act
- QA/QI:
-
Quality assurance/quality initiative
- RIS:
-
Radiology information system
- HIS:
-
Health information system
References
ACR. ACR Practice Parameter for Communication of Diagnostic Imaging Findings. Available at: http://www.acr.org/~/media/ACR/Documents/PGTS/guidelines/Comm_Diag_Imaging.pdf. Accessed September 30, 2015
Evers RW, Yousem DM, Deluca T, Beauchamp NJ Jr, Smith S: PACS and unread images. Acad Radiol 9:1326–1330, 2002
Smith JJ, Berlin L: Picture archiving and communication systems (PACS) and the loss of patient examination records. Am J Roentgenol 176:1381–1384, 2001
US Department of Veterans Affairs. Introduction to the VistA Monograph. Available at: http://www.ehealth.va.gov/vista.asp. Accessed June 10, 2015
Kuzmak PM, Dayhoff RE: The use of digital imaging and communications in medicine (DICOM) in the integration of imaging into the electronic patient record at the Department of Veterans Affairs. J Digit Imaging 13:133–137, 2000
Siegel EL: Economic and clinical impact of filmless operation in a multifacility environment. J Digit Imaging 11:42–47, 1998
US Department of Veterans Affairs. Radiology Picture Archiving and Communication Systems (PACS). VHA Directive 2011–005. Available at: http://www.va.gov/vhapublications/publications.cfm?pub=1. Accessed June 10, 2015
Brook OR, Kruskal JB, Eisenberg RL, Larson DB: Root cause analysis: learning from adverse safety events. Radiographics 35:1655–1667, 2015
Siegle RL: From errors to process improvement. J Am Coll Radiol 1:133–134, 2004
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Scope of the problem Identifying and monitoring unread radiology exams within the Veteran’s Affairs (VA) hospital enterprise-wide filmless electronic health record and the commercial Picture Archiving and Communication Systems (PACS).
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Bastawrous, S., Carney, B. Improving Patient Safety: Avoiding Unread Imaging Exams in the National VA Enterprise Electronic Health Record. J Digit Imaging 30, 309–313 (2017). https://doi.org/10.1007/s10278-016-9937-2
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DOI: https://doi.org/10.1007/s10278-016-9937-2