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Volume 12 No 4 I September 2016 33
Quality Practice
Case Study: Management of Patients with
Urgent and Significant Findings
A recent death investigated by a State
Coroner highlights the importance of
adhering to RANZCR Standard 5.5.3.
Scenario
Frank is working as a busy clincal
radiologist in a private practice
setting on Friday. He notices that
a patient, Mr Smith, who had a
CT of his chest earlier that day
for increasing shortness of breath
over the past week, has bilateral
lobar pulmonary emboli. Frank
immediately tries to contact Mr
Smith’s GP, only to find that the
practice is closed as she is on
leave. Frank also tries to contact
Mr Smith who does not answer
his phone. He reports the study
immediately and continues to try
to contact Mr Smith for the rest
of the afternoon without success.
With the practice due to close
shortly at 5pm, what should Frank
do next?
Discussion
Most clinical radiologists are aware
of their duty to communicate urgent
findings regarding a patient’s scan to
their referrer. What may be unclear or
unknown to clinical radiologists is their
duty in circumstances where a referrer
is uncontactable or in situations where
the referrer and the patient are both
uncontactable.
In accordance with The Royal
Australian and New Zealand College
of Radiologists (RANZCR) Standards
of Practice for Diagnostic and
Interventional Radiology Version 10.1, it
is clear that Frank has a duty of care to
ensure that Mr Smith receives timely and
appropriate treatment for his condition
that, if left untreated, may result in
serious harm or even death. In addition,
it is evident that Frank, in the absence
of Mr Smith’s referring GP, is the best
positioned person to co-ordinate the
next step of that care.
In situations where a patient is
uncontactable and requires immediate
medical attention, medical practitioners
should contact the ambulance or police
service, or another suitable authority
or service to perform a welfare check
and ensure that the patient receives
appropriate medical treatment.
The importance of this was highlighted
in a South Australian Coronial Inquest
relating to the death of a 69-year-old
woman in 2010. In that case, a CT scan
revealed a pontine haemorrhage that
was identified correctly by the reporting
radiologist. The finding was immediately
communicated to the referring GP who
was then unable to contact the patient
over the next six days, by which time she
was found deceased by her daughter.
Importantly, the patient had been seen
alive up to five days after her scan.
The Coroner deemed that the
unsuccessful phone calls made to
the patient by the GP practice were
not sufficient and that the GP should
have put in place a plan to ensure
that the patient was contacted. This
failure to contact the patient to
initiate urgent medical treatment was
considered likely to have contributed
significantly to the patient’s death. The
Coroner recommended that in such
circumstances medical practitioners
contact an ambulance or police service
to conduct a welfare check.
Relevant RANZCR Standard
5.5.3 Communication of Imaging
Findings and Reports
The practice shall ensure that reports
are made available in a clinically
appropriate, timely manner and shall
carry out regular reviews at least once
every year on the time between the
performance of the study and the
issuing of the report.
Indicators
1. The practice has a documented
policy for report turnaround times
which sets out expected turnaround
times for defined urgent and non-
urgent findings.
2. The practice maintains records
of regular reviews of reporting
turnaround times in accordance
with this policy, and implements and
records corrective action should
there be any indications that the
designated reporting times are not
being met.
3. If there are urgent and significant
unexpected findings, there is a
protocol which ensures that:
a) the reporting radiologist uses
all reasonable endeavours to
communicate directly with
the referrer or an appropriate
representative who will be
providing clinical follow-up;
b) a record of actual or attempted
direct communication is
maintained by the practice; and
c) the reporting radiologist co-
ordinates appropriate care for
the patient if they are unable to
communicate such findings to the
referring clinician.
Dr Ronny Low
Chair, CT Reference Group
If you have any questions or
comments, please contact Daisy
Garling, Senior Projects Officer,
Quality and Standards at daisy.