PLEASE NOTE: THIS RESOLUTION WILL BE DEBATED AT THE 2015 COUNCIL MEETING. RESOLUTIONS ARE NOT
OFFICIAL UNTIL ADOPTED BY THE COUNCIL AND THE BOARD OF DIRECTORS (AS APPLICABLE).
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RESOLUTION:
SUBMITTED BY:
SUBJECT:
32(15)
California Chapter
Critical Communications for ED Radiology Findings
PURPOSE: Assign a task force to create a list of imaging findings that should be communicated in real time from a radiologist and work with the ACR to develop a joint best practice guideline regarding those images that should be communicated in real time.
FISCAL IMPACT: Approximately $15,000 for an in-person meeting. Additional $5,000 for meeting with ACR and staff resources for initial meetings and conference calls to establish final consensus.
WHEREAS, Closed-loop communication between radiology and emergency medicine is critical to patient safety for certain serious, time-urgent conditions; and
WHEREAS, Failure to have adequate closed-loop communication may result in patient harm due to a delay in treatment; and,
WHEREAS, Certain imaging findings warrant real-time provider-to-provider communications due to the critical nature and the need for timely action; and
WHEREAS, Emergency physicians and radiologists should work together to develop guidelines as to which findings warrant real-time communication rather than leaving a final read in a chart or flagging an “action alert” within an electronic medical record; therefore, be it
RESOLVED, That ACEP appoint an internal task force to establish a list of imaging findings that should be communicated in real-time and in a closed-loop manner by the radiologist to the emergency provider, weighing the benefit of immediate communication of critical information against the risk of excessive interruptions in provider workflow; and be it further
RESOLVED, That ACEP work with the American College of Radiology to develop a joint best practice guideline regarding imaging findings that should be communicated in real-time and in a closed-loop manner by the radiologist to the emergency provider, weighing the benefit of immediate communication of critical information against the risk of excessive interruptions in provider workflow.
Background
This resolution asks the College to assign an internal taskforce to create a list of imaging findings that should be communicated in real time from a radiologist and work with the American College of Radiology (ACR) to develop a joint best practice guideline regarding those images that should be communicated in real time.
The ACR published the “ACR Practice Parameter for Radiologist Coverage of Imaging Performed in Hospital
Emergency Departments” in 2014. That document stresses the importance of timely imaging interpretation in the
ED and communication with emergency physicians. It stressed the need for these timely interpretations during both normal and after hours, and where resources are limited, suggested the use of teleradiology.

Resolution 32(15) Critical Communications for ED Radiology Findings
Page 2
In a second paper, “ACR Practice Parameter for Communication of Diagnostic Imaging Findings” in 2014, ACR outlines guidelines for non-routine communication. This includes findings that warrant immediate or urgent interventions – “…cases may occur in the emergency and surgical departments or critical care units and may include such findings of pneumothorax, pneumoperitoneum, or a significantly misplaced line or tube. Other urgent conditions typically included in ‘critical values’ categories” should be included.” In addition, they suggest non-routine communication for findings that were different from the preliminary read, and where findings would have an adverse effect if not treated immediately. The paper goes on to describe appropriate documentation and appropriate methods of communication. They stress the importance of directly reaching the provider, and if not possible, reaching the patient, and emphasized that this communication should be person to person. Finally, they discuss options for creating a closed-loop communication.
ACEP Strategic Plan Reference
Develop and promote delivery models that provide effective and efficient emergency medical care in different environments.
Work with community groups and other organization to promote opportunities for improvement and standardization for transition of care reporting/communication
Fiscal Impact
Approximately $15,000 for an in-person meeting. Additional $5,000 for meeting with ACR and staff resources for initial meetings and conference calls to establish final consensus.
Prior Council Action
None
Prior Board Action
None
Background Information Prepared by: Sandy Schneider, MD, FACEP
Emergency Medicine Practice Director
Reviewed By: Kevin Klauer, DO, EJD, FACEP, Speaker
James Cusick, MD, FACEP, Vice Speaker
Dean Wilkerson, JD, MBA, CAE, Council Secretary and Executive Director