Critical Results Notification System in the Electronic Health Record: Advancing Radiology and Patient Care

The Joint Commission identifies timely reporting as a major failure in medical care, making it a National Patient Safety Goal (NPSGs)^1,2. There is an urgent need for efficient systems to improve communication.

To develop and implement an electronic Critical Result (CR) notification system for radiology reports that aligns with the Joint Commission's NPSG-2 goals by tracking and reducing turnaround times (TATs).

Our institution designed a four-step framework to develop the CR computerized notification system, primarily customizing an existing Electronic Health Record (EHR) module to support the acknowledgment of 18 CR types. The system provided five acknowledgment pathways, including mobile phone integration, to enhance accessibility. To assess the system's impact, we collected six months of pre- and post-implementation data, calculating median TATs as the primary measure. Additionally, Winsorization techniques were applied to mitigate the influence of extreme values, allowing for further analysis using mean TATs.

The median TAT remained at 13 min before and after implementation. However, after applying Winsorization and analyzing mean TATs, the average TAT decreased from 34 min to 20 min, demonstrating improved efficiency when accounting for extreme values.

Despite the unchanged median TAT, the system improved operations by enabling real time tracking, supporting data driven interventions and automating critical result notifications, reducing the need for manual conduct and streamlining communication. While Winsorization techniques offer additional context in understanding the impact of extreme values, it is important to emphasize that the median remains the most appropriate and robust measure for evaluating TATs given the high variability in these measurements.

We successfully developed and implemented an electronic CR notification system within our Health Care institution, replacing over a decade of traditional manual workflow with an automated design that delivers data-driven actionable outputs. Most importantly, the system also established a foundation for real-time, structured queries within the EHR, allowing for continuous timestamp monitoring and improvement of TAT performance.