MGH Idiosyncrasies
1. All recommendations must be in a separate “RECOMMENDATIONS” section after the “IMPRESSION” section. This is not just imaging recommendations – it includes “clinical correlation” or “comparison with prior.” Since last year, a new system for important findings and follow-up recommendations has been put in place. They will likely go over those with you during orientation. Please let us know if you have questions about it.
2. If you find one of these 10 things on a study, and it is previously unreported/unknown, you MUST call the ordering physician and document talking to someone taking care of the patient (MD, PA, or RN) within 40 minutes of detection. Use the macro “Urgent Results” in Powerscribe to document that you talked to someone.
a. Unstable fracture
b. Pneumothorax
c. Pneumoperitoneum
d. Significantly misplaced catheter, line or tube
e. Leaking or ruptured aortic aneurysm (or aortic/carotid dissection)
f. Clinically significant pediatric intussusception
g. Acute intracranial hemorrhage
h. Ischemic bowel
i. Pulmonary embolism
j. Deep venous thrombosis
3. For most fractures, if patients are seen by ortho providers or if they are questioning a fracture at the location where you see it, you wouldn't need to send an alert or call them. However, if it is an unexpected fracture or something that seems like it would change management significantly, sending an alert or contacting the provider may be a good move.
4. If it’s an unexpected but not urgent finding (e.g. thyroid nodule that needs a thyroid ultrasound), use the Critical Findings or Follow-Up tools (mentioned above)