Use of CTRM
Within US-based hospitals, diagnostic
departments perform more than 12 billion radiology, laboratory, cardiology,
and pathology tests each year. While the
majority of these diagnostic tests are negative and require no follow-up with the
referring physician or care team member, approximately 4-5% of these tests
are deemed to be critical or abnormal,
which could indicate the patient is in imminent danger unless appropriate therapy or treatment is immediately initiated.
In these cases, interpreting physicians or
laboratories that use an automated Critical Test Result Management (CTRM)
protocol to alert the referring clinician
may be eligible for risk reduction discounts from their malpractice insurers.
CTRM systems send notifications of unexpectedly abnormal or urgent test results. The referring clinician phones into
the system and listens to the abnormal
result message. CTRM systems help ensure that the referring clinician retrieves
the abnormal test result through a combination of repeating alerts, escalations
to backup clinicians, and status update
messages to the diagnostic physician.
CTRM systems also document message
delivery, potentially providing effective
documentary evidence at trial.
In 2010, a study evaluated the experience of eight facilities that deployed
CTRM systems. With experience, their
notification data demonstrated a 50%
reduction in abnormal test result notification delivery time. 8 The concept
is attracting increasing attention from
healthcare organizations looking to ensure appropriate, timely treatment, while
improving patient safety and reducing
Underwriters interested in providing
discounts to healthcare organizations
and providers who use CTRM may find
that verification of use is needed. Reliable
documentation of abnormal test result
notifications plays a role similar to that
obtained via risk management training
certificates or monitoring of other patient
safety initiatives in healthcare facilities.
Depending on the source, however, the
documentation can be subject to conflict
of interest. Physicians and their service
providers share an incentive to maximize
the reported usage volume. As in other
industries, neutral third party auditors
can avoid this conflict because they are
not subject to the same incentives as the
insured physicians and their staff.
Diagnostic physicians and facilities have
new tools that can reduce the incidence
of abnormal test results that are not acted
upon, as well as the financial incentives
to use them. Malpractice liability insurance carriers and accrediting organizations can provide incentives to deploy
electronic notification systems. They
can use reports from external auditors
to confirm that the systems are used
1Sidel R, Lucchetti A. Banks Deepen Cost Cuts
in Push to Juice Profits. The Wall Street
Journal. July 21, 2011. Available at: http://
Accessed October 3, 2011.
2Morrison C, Marzano L. Patient Safety Strategies for Shoulder Dystocia: Lessons
Learned. The Doctors Company. Available
October 10, 2011.
3Gale BD, Bissett-Siegel DP, Davidson SJ, Juran
DC. Failure to notify reportable test results:
significance in medical malpractice. J Am
Coll Radiol. In press.
4Silverman JF, LiVolsi V, Fletcher CDM, et al.
Critical Diagnoses (Critical Values) in
Anatomic Pathology. Association of Directors of Anatomic and Surgical Pathology.
Available at: http://www.adasp.org/
v1.1.pdf. Accessed October 10, 2011.
5College of American Pathologists. Comments
to the National Quality Forum on The List
of Serious Reportable Events. July 12, 2011.
6American College of Radiology. ACR Prac-
tice Guidelines for Communication of
Diagnostic Imaging Findings. Revised
2010. Available at: http://www.acr.org/
aspx. Accessed October 11, 2011.
Brian Gale, MD, MBA is an assistant professor of
clinical radiology at SUN Y Downstate Medical Center
where he serves as director of radiology informatics.
He has led several research projects investigating
radiology communications and can be reached at