Immediate Action Required: Contact Your Ordering Physician Urgently
If you discover a missed critical finding on your radiology report, you must immediately contact the physician who ordered the imaging study (or their designee) to ensure the finding is addressed without delay, as failures in communicating critical results can lead to patient morbidity and mortality. 1
Step-by-Step Action Plan
1. Immediate Communication (Within Hours)
- Call the ordering physician's office directly during business hours
- If after hours or unable to reach them:
- Contact the on-call physician covering for them
- Go to the emergency department if the finding suggests immediate danger (e.g., large mass, aneurysm, pulmonary embolism)
- Call the radiology department that issued the report to speak with a radiologist
Critical findings require synchronous (real-time) physician-to-physician communication with documented acknowledgment of receipt. 1 As a patient discovering this gap, you are essentially closing a communication loop that should have already occurred.
2. Document Everything
When you make contact, document:
- Date and time of your call
- Name of the person you spoke with
- What was discussed
- What actions they committed to taking
- Follow-up plan and timeline
This creates your own audit trail, which is a standard component of critical finding management. 1
3. Request Immediate Review and Action Plan
Ask the physician to:
- Review the radiology report immediately
- Explain the clinical significance of the finding
- Provide a specific management plan with timelines
- Schedule any necessary follow-up imaging or specialist consultations
- Clarify if this represents a true critical finding or a less urgent issue
4. Escalate If Necessary
If you cannot reach your ordering physician or their coverage within 24 hours for what appears to be a critical finding:
- Contact the hospital's patient advocate or risk management department
- Request consultation with the interpreting radiologist directly
- Seek care in the emergency department if symptoms are present or the finding suggests immediate danger
The ACR guidelines emphasize that radiologists should escalate communication efforts when providers cannot be reached immediately, and this process should only terminate when appropriate acknowledgment occurs. 1 You are now performing this escalation function yourself.
Understanding the Context
Why This Happens
Communication failures in radiology are a major contributor to malpractice claims. 1 The system should have multiple safeguards:
- Direct closed-loop communication for high-acuity findings 2
- Documented audit trails 1
- Electronic alerts and acknowledgment systems 2
When you discover a missed finding, it represents a system failure at multiple levels.
What Constitutes "Critical"
Critical findings are those requiring immediate or urgent intervention to prevent patient morbidity or mortality. 1, 2 Examples include:
- Acute pulmonary embolism
- Pneumothorax
- Large masses suggesting malignancy
- Acute fractures with displacement
- Aortic dissection or aneurysm
However, even if the finding doesn't require immediate action, any significant abnormality that was not communicated to you warrants prompt follow-up. 3
Common Pitfalls to Avoid
- Don't assume someone else will follow up - The communication breakdown has already occurred; you must be proactive
- Don't delay because you feel well - Many critical findings are asymptomatic initially
- Don't rely solely on patient portals or messages - Use direct phone communication for urgent matters
- Don't accept vague reassurances - Insist on a specific action plan with timelines
Your Rights as a Patient
You have the right to:
- Understand all findings on your imaging studies
- Receive timely communication of critical results
- Request consultation with the interpreting radiologist 1
- Request a second opinion or overread if you have concerns 1
- File a complaint with the hospital's quality improvement or risk management department if communication standards were not met
The process for resolving discrepancies and communication failures should be incorporated into both hospital and radiology peer-review processes, 1 meaning your experience should trigger institutional review to prevent future occurrences.