MATERIALS AND METHODS The design decisions made for each step in the alert communication process, which includes user authentication, alert creation, alert communication, alert acknowledgment and management, alert reminder and escalation, and alert documentation, are described. To assess attitudes toward ANCR, internally developed and validated surveys were administered to all radiologists ( n = 320) and ordering providers ( n = 4323) who sent or received alerts 3 years after ANCR implementation. RESULTS The survey response rates were 50.4% for radiologists and 36.1% for ordering providers. Ordering providers were generally dissatisfied with the training received for use of ANCR and with access to technical support.

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Radiologists were more satisfied with documenting critical result communication (61.1% vs 43.2%; p = 0.0001) and tracking critical results (51.6% vs 35.1%; p = 0. Fabfilter Total Bundle Serial Mac here. 0003) than were ordering providers. Both groups agreed use of ANCR reduces medical errors and improves the quality of patient care.

The Joint Commission has made improved communication of critical results of diagnostic procedures among caregivers a National Patient Safety Goal []. To meet this goal, our institution established an enterprise-wide communication of critical test results policy [] with guidelines and procedures for notifying referring providers when critical imaging results are identified.

Initial policy implementation relied on mostly analog processes, including labor-intensive alert creation for a substantial volume of critical imaging results. Therefore, we developed an application, Alert Notification of Critical Results (ANCR), to facilitate critical imaging test result communication. Because the ANCR database contains details of closed-loop communication for critical results, it serves as a component of the electronic health record (EHR) and a source of data for relevant regulatory and safety audits. Therefore, as long as use of ANCR is documented in the relevant radiology report, the dependence on documenting details of the closed-loop communication in the radiology report with its associated delays can be eliminated. We describe the ANCR system components and the design decisions made to enhance workflow efficiency. We also report on provider satisfaction with ANCR and compare radiologists’ and ordering providers’ attitudes toward ANCR.

Materials and Methods The institutional review board granted approval for administering an electronic survey to providers at the institution to assess ANCR implementation for this HIPAA-compliant study. ANCR was designed and implemented at a 753-bed urban adult tertiary referral academic medical center in January 2010. The institution has a fully integrated EHR, and all physicians and care providers have access to hospital and clinic notes and laboratory, radiology, pathology, and microbiology result retrieval. All diagnostic imaging orders are placed via a computerized physician order entry system. System Purpose and Components ANCR was designed to provide urgent and semiurgent alert notification to referring providers when the radiologist deems imaging examination results critical or unexpected at the time of interpretation []. The ANCR functional and technical requirements are publicly available []. ANCR is a web-based application installed on an HP Pro-Liant DL380 G5 server (Hewlett-Packard) with two 3.00-GHz physical central processing units (eight cores total) and 8 GB random access memory running Microsoft Windows Server 2003 R2 Standard ×64 edition as the operating system with Microsoft Internet Information Services enabled to manage the website.