Part IV (61-81) Flashcards
Case 61
T or F: Regarding communication, timely receipt of the report outweighs the method of delivery
True
Case 61
T or F: Electronic or rubber-stamp signature devices, instead of a written signature, are acceptable unless contrary to state law, if access to such devices is secure
True
Page 61
T or F: When feasible, a copy of the final report accompany the transmittal of relevant images to other healthcare professionals, when such images are requested.
True
Page 62
Three levels of results based on urgency with regards to communications are present: define Level 1
New or unexpected findings that are life-threatening or would require immediate change in patient management (eg. PE, DVT, dissection, etc.)
Includes Critical Tests and Critical Results
Must be reported within 30-60 minutes
Case 62
Define Critical Result
Define Critical Test
Critical Result
- any result or finding that may be considered life-threatening or that could cause severe morbidity and require urgent or emergent clinical attention
Critical Test
- those tests that require rapid communication of results, whether normal, abnormal, or critical
Page 62
Three levels of results based on urgency with regards to communications are present: Define Level 2
New or unexpected findings on an imaging study that could result in mortality or significant morbidity if not appropriately treated urgently within 2-3 days
Eg. Abscess, impending pathological hip fx
Must be reported within 6 to 12 hours through a direct call or call service
Page 62
Three levels of results based on urgency with regards to communications are present: Define Level 3
New or unexpected findings that could result in significant morbidity if not appropriately treated
Not particularly time-sensitive but report shouldn’t be overlooked (eg. New lung nodule, renal mass)
Can be reported electronically but must be documented (who reported and who received it)
Page 63
What are the inherent risks associated with curbside consults or wet reads (eg. During clinical conferences, outside studies, when involved in other activities)?
Suboptimal reading conditions
No comparison studies
No prior reports
Inadequate access to patient records
It is encouraged to document these interpretations in some system of reporting to keep a record of it
Page 61
What 3 qualities should an effective method of communication have?
Be created to meet the need for adequate response
Promote the interpreting physician as a consultant and support physician-physician communication
Diminish the likelihood of communication errors
Page 63
What percentage of abnormal radiographic findings are missed?
What about pulmonary nodules?
30%
20% of lung nodules on CXR
Page 63
What percentage of radiologic interpretations rendered by radiologists in daily practice contain errors?
5%
Page 63
What is the most common cause of malpractice suits against radiologists?
Errors in diagnosis
Page 63
What are the four categories of diagnostic errors?
Failures in detection
Failures in interpretation
Failures in communication of results
Failures in suggesting an appropriate follow-up test
Page 63
Define cognitive errors
Usually errors a visual perception that occurred during scanning, recognition, and interpretation.
An example is missing a pulmonary nodule
Page 63
Define system errors
Errors that are usually attributed to health system issues or context of care delivery problems.
Example is failure to communicate the presence of a pulmonary nodule
Page 63
T or F: radiologic errors often result from a combination or interaction between cognitive and system errors
True
An example is a preliminary report by a resident that is revised in a final report but not fully communicated to the caregiver
Page 63
What are five cognitive biases that are particularly likely to lead to diagnostic errors in radiology?
MAPS F Multiple alternative bias Anchoring Premature closure Satisfaction of search
Framing
Page 64
T or F: The physician should keep inquiries and history taking, especially those of the sensitive nature, minimum during the course of a chaperoned examination
True
If a chaperone is provided, a separate opportunity for private conversation between the patient and the physician should be allowed
Page 65
Who regulates the marketing of drugs and devices?
Who regulates the use of drugs by physicians?
FDA
The states
Page 65
T or F: A physician’s free to use a drug or device for any purpose he feels is appropriate or necessary for patient care
True
Page 65
Define “off-label” use of a drug
The use of a drug or device in a manner that does not conform to the FDA approved labeling
Eg.
MRI contrast isn’t approved for pediatric use
Page 66
T or F: physicians are permitted to use any drug in whatever manner they choose in order to address the needs of the patient. This generally poses no medicolegal difficulty, especially if that particular to use has become commonplace.
True
Page 66
T or F: A physician or manufacturer may advertise off-label use of a particular drug or device per FDA-regulations.
False
Page 66
T or F: Drugs or devices used as part of a research study must be disclosed and may not be used for research without approval from the hospitals institutional review board
True
Page 67
What is the fundamental purpose of an institutional review board (IRB)?
To assure, both in advance and by periodic review, that appropriate steps are taken to protect the rights and welfare of humans participating as subjects in research
Page 67
Do IRBs have to register with?
Department of Health and Human Services
