Classification and communication of critical findings in emergency radiology: a scoping review.

Abstract

Purpose: To identify the published standards for the classification and communication of critical actionable findings in emergency radiology, and the associated facilitators and barriers to communication and message management/dissemination of such findings.

Materials and methods: Search terms for resources pertaining to critical findings (CFs) in emergency radiology were applied to 2 databases (PubMed, Embase). Screening of hits using the following pre-established inclusion and exclusion criteria were performed by 3 analysts with subsequent consensus discussion for discrepancies: 1) The resources include any standards for the classification and/or communication of imaging findings as critical OR 2) The resource discusses any facilitators to the communication of CFs OR 3) The resource discusses any barriers to the communication of CFs. Resources with explicit focus on a pediatric population or predominant focus on artificial intelligence/natural language processing were omitted. Accompanying gray literature search was used to expand included resources. Data extraction included: year, country, resource type, scope/purpose, participants, context, standards to identifying/communicating CFs, facilitators/barriers, method type, recommendations, applicability, and disclosures.

Results: Seventy-six resources were included in the final analysis, including 16 societal/commission guidelines. Among the guidelines, no standardized list of CFs was identified, with typical recommendations suggesting application of a local policy. Communication standards included direct closed-loop communication for high acuity findings, with more flexible communication channels for less acute findings. Applied interventions for CFs management, most frequently fell into 4 categories: electronic (n=10), hybrid i.e., electronic/administrative (n = 3), feedback/education (n=5), and administrative (n=4).

Conclusion: There are published standards, policies and interventions for the management of CFs in emergency radiology. 3-tier stratification (e.g. critical/urgent/incidental) based on time-sensitivity and severity is most common with most critical findings necessitating closed-loop communication. Awareness of systemic facilitators and barriers should inform local policy development. Electronic and administrative communication pathways are useful adjuncts. Further research should offer comparative analyses of different CF interventions with regards to cost-effectiveness, notification time, and user feedback.