Application for reporting adverse contrast reactions significantly increases radiologists’ thoroughness
Utilizing an electronic application for reporting adverse reactions to contrast agents helped significantly increase radiologists’ thoroughness, according to research published Wednesday in JACR.
Ensuring patient safety requires documenting these incidents, which typically occurs in the electronic health record module tracking an individual’s allergy history. However, contrast reactions are often unrelated to allergies, and providers can easily delete these entries, Massachusetts General experts noted.
The Harvard-affiliated institution has piloted the use of a new tool called CISaR (Contrast Incident Support and Reporting) to improve documentation. In just nine months, it has reached full adoption and become the primary method for incident tracking.
“Our findings demonstrate that the implementation of a semistructured electronic application for adverse contrast reaction reporting significantly increased both the frequency and completeness of radiologists’ documentation of these events,” corresponding author Tarik Alkasab, MD, PhD, associate chair for enterprise informatics and IT in Mass General’s Department of Radiology, and colleagues concluded. “By reliably documenting information needed to guide future contrast use, future care of these patients will be improved.”
CISaR is a browser-based application, developed in-house and accessed via the institution’s intranet. Responding radiologists fill out the form, including the type of adverse event, class of contrast used, reaction severity, and treatments administered. The tool also interfaces with the EHR, generating an imaging note displayed in the patient chart and text message with future contrast-exposure recommendations.
Alkasab et. al performed a retrospective analysis of all CT and MRI exams administered between February 2018 and December 2019 at their large academic hospital and multiple outpatient centers. They separated the data into three time periods: 10 months leading up to implementation (pre-CISaR period), the three months after launch (early adoption), and 12 months following that (post-intervention).
Altogether, researchers included 431 imaging exams with adverse reactions in the study. Half had radiologist documentation in the pre-CISaR, increasing to 66% during early adoption and 89% in the post-intervention phase. The application also significantly increased the percentage of radiologist documentation detailing contrast agent class, reaction severity and type, and future recommendations, with inclusion for each above 95%, the authors reported.
“A small percentage of studies with incomplete documentation remains, which may be due to lack of familiarity with the CISaR tool,” the authors noted. “Ongoing efforts to maintain and further improve the rate of documentation compliance include an annual contrast safety lecture to first-year residents, reminder e-mails to new fellows, and online resource centers.”
Marty Stempniak has covered healthcare since 2012, with his byline appearing in the American Hospital Association's member magazine, Modern Healthcare and McKnight's. Prior to that, he wrote about village government and local business for his hometown newspaper in Oak Park, Illinois. He won a Peter Lisagor and Gold EXCEL awards in 2017 for his coverage of the opioid epidemic.