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© Tameside NHS Foundation Trust

Reviewing Radiology Results

AED14

Version 3.1

Operational Areas Included

Emergency Department

Roles Responsible for Carrying out this Process

ED Doctors

ED Consultants

Operational Areas Excluded

All areas other than the Emergency Department

Associated Procedures

GEN01 Logging into Lorenzo

AED12 Requesting Radiology

TAMESIDE HOSPITAL NHS FOUNDATION TRUST Reviewing Radiology Results

Version 3.1 20/12/2012

CHECK THE INTRANET FOR LATEST VERSION


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Contents Reviewing Radiology Results ....................................................................................................................... 1

Reviewing Radiology Results. ...................................................................................................................... 5

ED Doctor - Notification that Radiology Results are Available ................................................................... 7

Reviewing the Radiologist’s Reports........................................................................................................... 11

Appendix 1: Results Table Headings .......................................................................................................... 15

Appendix 2: Results Table Icons ................................................................................................................ 16

Appendix 3: Results Icons .......................................................................................................................... 17


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Process Flow

ED whiteboard indicates that radiology results are available

ED Doctor

Review image

ED Doctor

Acknowleges scan with comments


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Radiographers Report

ED Receptionist

Identify patients where a fracture has been recorded


ED Receptionist

Check that each patient with a reported fracture has a follow up appointment scheduled


ED Consultant

Advise the required action for patients that have had a fracture identifed and no follow up fracture clinic appointment


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Reviewing Radiology Results.

Radiology Results When the radiology exam is complete, this is indicated on the ED whiteboard. For results that are considered abnormal and urgent, a member of the radiology staff will walk around to the emergency department to inform them of the abnormal results For abnormal, but not urgent and normal results, the appropriate column on the ED whiteboard will display a numerical value to indicate the number of tests ready for review The ED Doctor attending the patient will review the X-ray image and acknowledge the results with comments. Once the results have been acknowledged, further comments regarding the review of the image should be recorded in the electronic CAS card. Radiology Results are primarily reviewed on a patient by patient basis. Radiographer’s Report The initial results following a radiology request will be the image itself and a brief summary report. This is used by the attending Doctor to make their initial assessment. The Radiologist will then write a further report of their assessment of the image. There is a service level agreement that these reports are received within 48hrs of the request. Once the radiographer’s report is available the reception staff will identify the patients where the Radiographer has identified a fracture. For each patient where a fracture has been identified, the receptionist will check to ensure that the patient has a fracture clinic appointment. If the patient has a fracture clinic appointment, then no further action is required. If the fracture clinic appointment has not been made then the receptionist will refer the patient to the ED Consultant to decide the required action


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Activity Additional Guidance

1. Use GEN01 Log in to Lorenzo using your smart card Defaults to My work tab.

2. Within the Action pane scroll and select Emergency Department from the My work menu.

3. The ED current view will display.

To ‘hide’ the Options pane to and increase the view of the

department click the peg in the top right of the options pane.


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4. ED Doctor - Notification that

Radiology Results are Available

When the Radiology scan has been completed a numerical value based on the number of test results available will display in the Requests and Results columns

5. There are three columns on the ED whiteboard that relate to Radiology Scan results

1) All Completed Tests All completed tests, Pathology and Radiology will display

as a ‘count’ in the Results Available since encounter column

2) Results that Need Acknowledgement

If the Radiology results need to be acknowledged then the

count will also display in the Results pending acknowledgement for requests placed since

encounter started column

3) Radiology Image complete, awaiting Radiographer’s Report

If the radiology image is complete but not yet reported on

the the count will display in the Imaging exams performed with results pending for requests placed

since encounter started column

6. Select the ‘count’ hyperlink in the Results Available since encounter column


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7. The patient’s record will display at the Results / Requests tab Check the yellow banner bar to ensure you have selected the correct patient. Please see Appendix 2 – Results Tables Headings for a description of each of the columns displayed

8. In the patient’s EPR record it will display all the Radiology and Pathology requests that have been placed for the patient. The date and time requested and the request status to identify the results you would like to view.

9. Use of Filters Filters can be used to help identify the results to be reviewed. Use the Unseen filter, will display only Pathology and Radiology results that have not been viewed yet. Use the Unacknowledged filter to display those results that require Acknowledgement.

10. Select the name hyperlink of the test you would like to view the results for


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11. The results will display in the lower half of the screen.

Click and Drag the bar to expand the view

12. A summary report will display.

For a full list of the possible icons displayed please see Appendix 3- Results Icons

13. Click the link to open PACS and view the image

14. PACS will automatically open to display the scan image When you close PACS you will be returned to the results in the patient’s EPR.


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15. When the attending Doctor has reviewed the image they should acknowledge the results, recording their comments.

Select the Acknowledge with Comments

Once the results have been acknowledged, further comments regarding the review of the image, should be

recorded in the electronic CAS card.

16. The free text comments box will display. The reviewing Doctor should record the decisions and action taken following review of the results. Note: You may want to copy this text to transpose into the patient’s CAS card. Click OK

17. The request will now display with a Result Workflow Status of Acknowledged Results

18. The comments should also be recorded in the patient’s CAS card. Record the comments in Section 4: Doctors Assessment There is a field for Radiology Results comments, record your comments here


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Reviewing the Radiologist’s Reports


1. Once the radiologist’s reports are available the reception staff will identify the patients where the Radiologist has identified a fracture. When text reports are received from Radiology (SLA within 48hrs of the request) then reception will review the reports. They will then perform a check to ensure that the patient has an appointment booked with the Fracture clinic. If the patient has been referred to the fracture clinic then no further action is required. To look to see if the patient has a fracture clinic appointment scheduled please refer to SOP GEN18 Viewing Appointment History If the fracture clinic appointment has not been made then the receptionist will refer the patient to the ED Consultant to decide the required action

2. Viewing the Radiology Image For each patient that the receptionist has identified as having a reported fracture but no fracture clinic appointment, the ED Consultant should review the image and report to decide an appropriate course of action. Select the Patient tab

3. The patient’s hospital number and NHS number will display on the report. Enter the patient’s hospital number in the identifier field and

click the green arrow

4. The matching record will display in the lower half of the screen.


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5. To open the patient’s record, select either the PAS Number or the patient’s name

6. The patient’s record will display. Check the yellow banner bar to ensure you have the correct patient

7. Use the up and down arrows to move down to locate and select the Results / Requests tab

8. The requests and results for the patient will display. Those results pending acknowledgement are indicated by

the icon.

9. Select the Investigation


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10. Click the icon in the bottom right of the screen

11. The results will be displayed.

12. The report is shown towards the top of the results

13. Scroll down to read more, if required

14. The original Doctors comments can be seen in the Acknowledgement comments field


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15. Click the link to open PACS and view the image

16. PACS will automatically open to display the scan image When you close PACS you will be returned to the results in the patient’s EPR.


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Appendix 1: Results Table Headings Heading Name Description

Investigation Name The name of the requested item (e.g. Full Blood Count or XR Chest)

Service Department The Service Department the request is attached to as assigned in system configuration e.g. General Radiology, Haematology, Biochemistry etc.

Request Status Denotes the status of the request e.g. placed, performed, cancelled etc.

Requested Date & Time Date Time the request was placed.

Result Workflow Status Current workflow status of the result, i.e. pending acknowledgement, pending authorisation etc.

Result Status Status of the result i.e. preliminary, final etc.

Result Reported Date & Time The date the result was reported.

Sample/Performed Date & Time The date / time the sample was collected.

Requested By The name of the Lorenzo User who requested the item.

Request Priority The priority of the request (e.g. Urgent, Routine etc.)

Result Required Date The date / time a result is required on.

Group Reference Number The unique reference number for the group of items requested. If only one item is requested the Group Reference Number and Request Reference Number may be the same.

Request Reference Number The unique reference number for an individual request item.

Review Category The category of the review as assigned in system configuration e.g. Pathology, Imaging etc.

Request Type The type of request being placed (e.g. usually set to Standard).

Specimen Status The status of the specimen collection (e.g. Specimen collected, Pending specimen collection). If Specimen collection is not appropriate for the request item (e.g. Chest X Ray) then this column will display ‘Not Applicable’.

Encounter Info. Details of the encounter attached to the request including Encounter Type, Encounter Identifier, Encounter Start Date / Time). (e.g. Inpatient, Outpatient Encounter)

Booked Date/Time The date/time the relevant department are planning to carry out the test.

Request to be Performed Date & Time

The date the request should be performed on.

Specimen Details Details of the required specimen.


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Appendix 2: Results Table Icons Icon Description

Abnormal results. This flag indicates that the results have been flagged as abnormal by the ancillary system (e.g. Pathology, Radiology System).

Results pending acknowledgement This icon indicates that the result is pending acknowledgement. Once authorised, clicking on this icon will open the acknowledge results window.

This icon indicates the results have been acknowledged.

This icon indicates the results have been amended / modified.

This icon indicates that the results have been marked as Confidential.

Solicited result. For example, a request was placed in Lorenzo and a result is messaged into Lorenzo for the same request placed.

Unsolicited result. For example, a result is messaged to Lorenzo for a request that was not placed in Lorenzo (e.g. via GP, via telephone / paper)

This icon indicates the request was not placed using Lorenzo. (e.g. the request is dynamically created when an unsolicited result is messaged into Lorenzo to maintain the hierarchy)


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Appendix 3: Results Icons

Icon Description Tooltip

Low

Very Low

High

Very High

Pending authorisation. No tooltip is displayed, but the

following text is displayed when a user tries to view the result.

Comments have been added to the result.

Results have been marked as confidential

Once authorised, users with the appropriate rights can view the results.


Document Control

Version Number

Date Document Status Author / Modifier / Reviewer Details Approved Signatory

0.0 18/02/2013 Draft Mike Maitre Initial Draft

0.1 13/03/2013 Draft Claire Templar Review

0.3 13/03/2013 Draft Mike Maitre Update following review

0.4 05/04/2013 Draft Rachel Mitchell Reviewed

2.0 10/05/2013 Draft Monika Vorberg Updated following BPV

2.0 30/05/2013 Draft Mike Maitre Include PACS link and Image

3.0 12/07/2013 Final Mike Maitre Updated to Final

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