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In
the ICAEL Standards, several references are made to preliminary
reports. This article will attempt to clarify several of
the more frequently asked questions related to preliminary reports.
The specific area in the ICAEL Standards for Adult and
Pediatric Transthoracic Echocardiography, Part I, Organization,
Section 3.2.2 and 3.2.3 relative to preliminary reports states:
3.2.2
Preliminary reports prepared by the physician should be completed
within 24 hours (verbal or written) with final reports completed
within 48 hours. STAT reports should be available immediately,
if possible. URGENT reports should be available the same day.
Note:
Suggested method for reporting life-threatening findings:
Optimally, the interpreting physician in the laboratory will
call the appropriate physician.
3.2.3
If preliminary
reports are issued, their preliminary nature should be clearly
indicated. Verified final reports should be provided within
48 hours after the posting of preliminary results. A mechanism
for communicating any significant changes must be defined
for those situations in which the final interpretation differs
substantially from the preliminary report.
Note:
Sonographer worksheets, comments, or other communication of
findings must not be issued as preliminary reports for the
purpose of clinical management.
Based
on the increasing number of preliminary report-related questions
received via the new interactive Frequently Asked Questions
(FAQ) section of the website, the ICAEL felt it necessary to
explore this topic further, and hopefully offer some insight
and clarity into the role of preliminary reports.
Preliminary
reports, first and foremost, should not be confused with the
sonographer's worksheet provided to the interpreting physician
or fellow, or comments or notes that a sonographer places in
the patient's chart that are not related to the specific findings
of the echocardiogram, such as "echocardiogram completed,
report to follow." Preliminary reports frequently are
those prepared by a fellow or resident but not yet reviewed
by the interpreting physician, often intended for patient management.
The
ICAEL strongly discourages the use of sonographer-prepared preliminary
reports, worksheets or verbal reports that would be used for
the purpose of clinical management. If life-threatening findings
are present, ideally the interpreting physician would notify
the referring physician immediately.
The
Organization application, Part I, Page 24, contains several
questions about who provides the preliminary reports and whether
the laboratory has a policy for reconciling differences between
preliminary and final reports. A policy for reconciling differences
is necessary only if a) the findings provided by the resident
or fellow differ from the final interpretation provided by the
interpreting physician, b) the sonographer gives verbal findings
to the referring physician or nurse, or c) the sonographer writes
preliminary findings in the patient's chart. A reconciliation
policy is necessary in the event that the interpreting physician
disagrees with the fellow, resident or sonographer's findings.
With proper protocols for reconciliation in place, the laboratory
can readily notify the referring physician of the differences
and ensure that the patient's treatment will not be based on
incorrect findings.
A
good reconciliation policy should address what constitutes a
"substantial" difference between the final interpretation
and the preliminary interpretation, how the referring physician
will be notified, and who is responsible for notifying the referring
physician.
Have
a question of your own? The ICAEL encourages further discussion
on this topic. Please feel free to enter your question in the
FAQ Manager, located on the Frequently Asked Questions
page of the ICAEL website at www.icael.org/icael/accreditation/faq.htm.
If you have a more specific question related to your own laboratory,
or would like to speak to someone personally, please contact
Cassie Robbins, RDCS, FASE, ICAEL Technical Manager, at 410-872-0100
or via email at robbins@intersocietal.org.
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