The trusted source for
healthcare information and
Nurses take ownership of rads discrepancies
New process improves communications
A new process for managing radiological discrepancies in the ED at Catawba Valley Medical Center in Hickory, NC, has significantly improved the efficiency with which notifications are received and acted upon.
"Nursing owns this process and relies on the physicians only for order corrections or additions," says Van Haygood, RN, MSN, NE-BC, administrator for emergency, post-procedural, and direct admission services.
"I guess we have been doing this exactly as we do it now for about four years," says Haygood, citing several reasons for the change. For one, a new Patient Archives and Communication System (PACs) was acquired, Haygood says. "After the upgrade, we addressed the old process, where radiologists would fill out a pink slip and have it brought over to the ED," he says. "Some slips made it to the box, some didn't, and sometimes the doctors wouldn't see them, so we decided to take it upon ourselves to develop another process."
Team developed game plan
The new process was developed by a team that included Haygood and the ED medical director. "We identified the key issues and determined exactly what we needed to do to fix them," he says.
The new process works like this: First, as always, films are taken as ordered by the ED physician, who then reads them. All those films are then overread by a radiologist.
"If there is a discrepancy they are required to write it up," says Julie Carrigan, RN, BSN, CEN, one of two patient care coordinators designated to oversee the new process.
If the physician still is in the building, the radiologist will call him or her and give notifications about the discrepancy. "For example, they may tell them they found a discrepancy in a chest X-ray and suggest a CT scan," she says. However, sometimes they might be read after the patient has been discharged, which makes the situation a little more complicated, Carrigan reports.
"Each day, myself and the other patient care coordinator go to the computer system to see if there is a discrepancy. If there is, it's listed on the PACS system," Carrigan says. "We print the discrepancy off, pull the chart, and review the diagnosis and treatment with one of the ED physicians." The physician will tell them what follow-up needs to be done, i.e., a return visit for additional testing, an outpatient visit, or referral to a specialist, she says. Carrigan or the other coordinator then will contact the patient and/or the specialist to arrange for the follow-up.
"I then go back into the PACS, where there is a place for a 'discrepancy acknowledgement,'" she says. "I will either enter the fact that I was not able to get in touch with the patient and will send a letter, or, if did I contact them, I type it in the system and the discrepancy goes away."
New process is 'much more timely'
Before, Haygood explains, the MDs were independently responsible to remember to look at the discrepancy reports, pull the necessary records, make decisions in writing, and place the hard copy into a bin so that the charge nurses, in turn, could call patients if necessary and arrange for further testing. "The issues were that the MDs got busy, didn't take the time to look at the reports, and hated the process, so they tended not to want to get involved," he says.
There was not much training needed to implement the new process, says Julie Carrigan, RN, BSN, CEN, one of two patient care coordinators. "I just really needed to learn how to access the PACS system," she says. In addition, says Haygood, "the ED medical director had been doing this, so she taught Julie."
Any ED that has a PACS could implement such a process, says Haygood. "If they don't, but if they have any kind of radiological overread system, then someone in the department needs to be designated to do what Julie does," he says.
"You have to have a designated person responsible to do this on a regular basis," says Haygood. In addition, he notes, "I don't think this person can be a secretary. It should be a nurse who is able to understand what the doctor wants."
The reason? The new process, in effect, has taken the MDs "out of the loop" except to present them with the report and obtain immediate feedback in the form of orders, Haygood says. "These orders can only be written and acted upon by an RN thus, no secretarial involvement," he says.