Radiology report alerts - are emailed 'Fail-Safe' alerts acknowledged and acted upon?

Guidelines from the Royal College of Radiologists and National Patient Safety Agency highlight the crucial importance of "fail-safe" alert systems for the communication of critical and significant clinically unexpected results between imaging departments and referring clinicians. Electronic alert systems are preferred, to minimise errors, increase workflow efficiency and improve auditability. To date there is a paucity of evidence on the utility of such systems. We investigated i) how often emailed radiology alerts were acknowledged by referring clinicians, ii) how frequently follow-up imaging was requested when indicated and iii) whether practise improved after an educational intervention.

100 cases were randomly selected before and after an educational intervention at a tertiary referral centre in London, where the email-based 'RadAlert' system (Rivendale Systems, UK) has been in operation since May 2017.

Following educational intervention, 'accepted' alerts increased from 39% to 56%, 'abandoned' alerts reduced from 55% to 37% and 'declined' alerts decreased from 5% to 3%. There was evidence to confirm that, when indicated, further imaging had been requested for 78% of all alerts, 78% of 'accepted' alerts and 76% of 'abandoned' alerts both before and after educational intervention.

Acknowledgment of report alerts by referring clinicians increased after departmental education / governance meetings. However, a proportion of email alerts remained unacknowledged. It is incumbent on reporting radiologists to be aware that electronic alert systems cannot be solely relied upon and to take the necessary steps to ensure significant and clinically unsuspected findings are relayed to referring clinical teams in a timely manner.