Implementation of a Semistructured Clinical Event Documentation Tool for Acute Adverse Contrast Reactions |
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| Institution: | 1. Department of Radiology, Massachusetts General Hospital, Harvard Medical School, Boston, Massachusetts;2. Radiology Quality and Patient Safety Officer, Department of Radiology, Massachusetts General Hospital, Boston, Massachusetts;3. Vice Chair for Quality, Department of Radiology, Massachusetts General Hospital, Harvard Medical School, Boston, Massachusetts;4. Associate Chair for Enterprise Informatics/IT, Department of Radiology, Massachusetts General Hospital, Harvard Medical School Boston, Massachusetts;1. Director, 3D and Advanced Imaging Laboratory, and Director, Center for Practice Transformation in Radiology, Department of Radiology, Perelman School of Medicine, University of Pennsylvania, Philadelphia, Pennsylvania;2. Center for Research and Innovation, American College of Radiology, Philadelphia, Pennsylvania;3. Lead Statistician, Center for Research and Innovation, American College of Radiology, Philadelphia, Pennsylvania;4. Department of Radiology, Perelman School of Medicine, University of Pennsylvania, Philadelphia, Pennsylvania;5. Director, Software Engineering, American College of Radiology, Reston, Virginia;6. Medical Director, Jefferson Outpatient Imaging-Collegeville and Washington Township, Department of Radiology, Thomas Jefferson University, Philadelphia, Pennsylvania;7. Chief, Division of Abdominal Imaging, Medical Director, MRI, and Co-Director, Division of Radiology Innovation and Value Enhancement, Department of Radiology, Penn State Hershey Medical Center, Hershey, Pennsylvania;8. Associate Vice Chair Quality, Radiology, Perelman School of Medicine, Department of Radiology, University of Pennsylvania, Philadelphia, Pennsylvania;1. Associate Section Chief, Breast Imaging and Intervention Section, Associate Program Director, Breast Imaging Fellowship, and Associate Program Director, Diagnostic Radiology Residency, Department of Radiology, University of Wisconsin School of Medicine and Public Health, Madison, Wisconsin;2. Assistant Professor, Department of Biostatistics and Medical Informatics, University of Wisconsin School of Medicine and Public Health, Madison, Wisconsin;3. Associate Dean of Team Science and Interdisciplinary Research and Deputy Executive Director of the Institute for Clinical and Translational Research, Department of Radiology, University of Wisconsin School of Medicine and Public Health, Madison, Wisconsin;4. Chief, Breast Imaging at Magee-Womens Hospital of UPMC, Director, Quality in Breast Imaging, and Vice Chair of Quality Assurance and Strategic Development, Department of Radiology, University of Pittsburgh, Pittsburgh, Pennsylvania;5. Department of Radiology, University of Pittsburgh, Pittsburgh, Pennsylvania;6. Executive Vice President for Quality and Safety, American College of Radiology, Reston, Virginia;7. Peer Learning Lead Long Island Division Breast Imaging NYU, Department of Radiology, NYU Langone Health, New York, New York;1. Department of Radiology, Stanford University School of Medicine, Stanford, California;2. Department of Radiological Sciences, University of California, Los Angeles, David Geffen School of Medicine, Los Angeles, California;3. Assistant Director of Research Evaluation and Assessment, Department of Radiology, Stanford University School of Medicine, Stanford, California;4. Assistant Fellowship Program Director, Cardiovascular Imaging, Department of Radiology, Stanford University School of Medicine, Stanford, California;5. Co-Chair, ACR Ultrasound LI-RADS®;6. Division Chief, Director of Ultrasound, and Assistant Fellowship Program Director, Body Imaging, Department of Radiology, Stanford University School of Medicine, Stanford, California;1. Assistant Professor, Department of Radiology and Imaging Sciences, Indiana University School of Medicine, Indianapolis, Indiana;2. Clinical Research Coordinator, Department of Radiology and Imaging Sciences, Indiana University School of Medicine, Indianapolis, Indiana;3. Professor, Department of Radiology and Imaging Sciences, Indiana University School of Medicine, Indianapolis, Indiana;1. Roslyn, New York;2. Einstein Healthcare Network, Philadelphia, Pennsylvania |
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| Abstract: | PurposeTo improve the efficiency and accuracy of clinicians documenting acute clinical events related to contrast agent administration using a web browser–based semistructured documentation support tool.MethodsA new tool called Contrast Incident Support and Reporting (CISaR) was developed to enable radiologists responding to contrast reactions to document inciting contrast class, type of event, severity of contrast reaction, and recommendation for future contrast use. Retrospective analysis was conducted of all CT and MRI examinations performed between February 2018 and December 2019 across our hospital system with associated contrast reaction documentation. Time periods were defined as before tool deployment, early adoption, and steady-state deployment. The primary outcome measure was the presence of event documentation by a radiologist. The secondary outcome measure was completeness of the documentation parameters.ResultsA total of 431 CT and MRI studies with reactions were included in the study, and 50% of studies had radiologist documentation during the pre-CISaR period. This increased to 66% during the early adoption period and 89% in the post-CISaR period. It took approximately 9 months from the introduction of CISaR to reach full adoption and become the main method for adverse contrast reaction documentation. The percentage of radiologist documentation that detailed provoking contrast agent class, severity of reaction, reaction type, and future contrast agent recommendation all significantly increased (P < .0001), with greater than 95% inclusion of each element.ConclusionThe implementation of a semistructured electronic application for adverse contrast reaction reporting significantly increased radiologist documentation rate and completeness of the documentation. |
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| Keywords: | Compliance contrast media documentation drug hypersensitivity electronic health records gadolinium iodinated |
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