Critical Findings: Timing of Notification in Neuroradiology

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Fig 1.
Distribution of total notification times of all CFs.

Table 1:

Approved list of neuroradiologic critical findings⁴

Findings

1) New hemorrhage (epidural, subdural, intraparenchymal, subarachnoid, intraventricular, intramedullary)
2) New stroke
3) New mass, markedly enlarging mass
4) New herniation
5) Increased intracranial pressure, brain edema
6) New or worsening hydrocephalus
7) Misplaced surgical drainage catheter
8) Misplaced surgical hardware
9) Findings suggestive of meningitis or abscess
10) Incompletely clipped aneurysm
11) Clipped normal vessel
12) Findings suggestive of child abuse
13) New or enlarging aneurysm or AVM
14) Cord compression
15) New or enlarging cord mass
16) Suspected cord infarction
17) Spinal ligamentous injury in a trauma patient
18) Findings of spinal instability in a trauma patient
19) Congenital variations that may alter a surgical approach
20) New aneurysm, AVM, or vascular malformation

Reprinted from the Journal of the American College of Radiology, Volume 10/Issue 1, Stacey A. Trotter, Lukasz S. Babiarz, Valentina G. Viertel, Paul Nagy, Jonathan S. Lewin, David M. Yousem, Determination and Communication of Critical Findings in Neuroradiology, pages 45–50, 2013, with permission from Elsevier.

Table 2:

Total time from CF discovery to referring physician notified by shift

Shift	Total No. of CFs	Time from CF Discovery to Call Made to Physician (Notification Time) (min)	Time from CF Discovery to Referring Physician Notified (Total Communication Time) (min)	Time from Study Completed to CF Identified (min)
8 am to 4 pm (weekday)	37
Mean/SD		2.4/2.8	7.4/3.9	94.7/87.4
Mode		0	10	81
Median		1	7	72
4 pm to 11 pm (night)	24
Mean/SD		2.5/2.9	7.8/6.9	49.8/45.7
Mode		0	5	11
Median		2	5	44
11 pm to 8 am (overnight)	24
Mean/SD		5.6/3.6	10.1/7.6	31.6/37.8
Mode		3	15	9
Median		5	9	18
8 am to 4 pm (weekend)	6
Mean/SD		8.7/9.0	16.8/13.1	33.5/23.9
Mode		3	None	None
Median		4.5	11.5	22
All shifts	91
Mean/SD		3.7/4.1	8.8/6.9	62.2/69.0
Mode		0	5	16
Median		3	8	43

Table 3:

Elapsed times for top 5 services

Service	Total No. of CFs	Mean Response Time (min)	Range (min)	SD	Mode (min)	Median (min)	Mean Notific. Time (min)	SD	Mean Total Comm. Time (min)	SD
Emergency	31	3.4	21	4.3	1	2	5.3	7.9	8.7	8.5
Neurosurgery	18	6.5	33	7.7	5	5	2.7	3.3	9.2	8.1
Medicine	10	5.6	13	4.7	1	4.5	2.8	3.7	8.4	4.9
Neurology	9	7.2	23	7.8	2	5	3	2.1	10.2	8.7
Intensive care	9	2.8	7	2.4	2	3	4.7	3.3	7.4	4.3