Purpose or Case Report: Critical alert systems have been implemented to assist radiologists in contacting clinicians and documenting critical findings on imaging. These systems serve as a safety net for patients, facilitating timely, accurate communication of findings. The purpose of this study was to review the critical findings sent through the messaging system at a children’s hospital to determine utilization by radiologists and providers.
Methods & Materials: The usage of the critical alert system at a children’s hospital from 2016 to 2019 was reviewed. When the severity of a finding was discordant with the institution’s standard classification system, the author of the message was blinded and the discrepancy reviewed by the department quality and safety officer. Incidental findings and recommendations for further imaging in the alerts were also reviewed.
Results: 1,846 alerts were sent in regards to 1,777 critical findings in patients age 16 and younger. The most common exams were chest radiographs, followed by computed tomography (CT) of the head, and abdominal ultrasound (US). The severity of 16% of alerts was reclassified. Following reclassification, 30% of findings were yellow (compliance goal of 24 hours), 45% orange (compliance goal of 12 hours), and 25% red (compliance goal of 1 hour). The findings were communicated directly to providers in 83% of cases, with the automated messaging system used in 17% of cases.
Overall, 51% of alerts were sent by residents and 49% by staff; however, a trend towards an increase in resident usage was noted, with 64% of alerts sent by residents in 2019. The most common department contacted was the emergency department, which received 45% of alerts, followed by the neonatal intensive care unit (ICU) and pediatric ICU. 5% of alerts were sent to outreach hospitals and clinics.
Incidental findings were found on 7% of examinations. Recommendations for follow-up imaging was made in 23% of cases and specialty consultation was recommended in 3% of cases.
Conclusions: Utilization of the critical alert system was most common in critically-ill patients in the emergency department and ICU. The preferred method of communication is direct contact with providers with the alert system used to document and reinforce findings; however, the message system was needed to contact providers.
While incidental findings are uncommon in the pediatric population, follow-up imaging is often recommended. Documentation of these recommendations through the alert system may facilitate follow-up.