Guidelines for contrast reaction documentation would prove beneficial

No standards currently exist for radiologists to follow during the documentation of contrast reactions, but according to a recent research article in the Journal of the American College of Radiology, the creation of such standards could lead to improved documentation and better overall patient care.

Stephen Balfour, MD, of the department of radiology at Temple University School of Medicine, and colleagues noted that standards are in place for the documentation of advanced cardiovascular life support codes and other emergencies.

Not having something similar in place for the documentation of contrast reactions seemed like a missed opportunity to the Balfour and his co-authors.

“Direct documentation in a patient’s chart and transfer of care are skills that practicing radiologists may not exercise for extended periods of time, yet they are essential to patient safety in the rare event of a severe contrast reaction,” the authors wrote. “No national standard for the documentation of contrast reactions exists, and to our knowledge, no studies have been conducted to evaluate radiologists’ documentation of contrast reactions.”

To address that last issue, the team used the American College of Radiology Manual on Contrast Media and the American Heart Association’s “Guidelines for Cardiopulmonary Resuscitation and Emergency Cardiovascular Care” to develop their own standards. The final result was 22 different criteria that should, in the team’s estimation, be a part of all contrast reaction documentation.

The team then carried out clinical simulations with 18 senior and junior radiology residents, asking each one to show how they would document a contrast-induced anaphylactic shock in a progress note and then transfer care to a medical team, and judged those residents based on their own criteria.

Overall, the residents’ documentation contained anywhere from 12 (54%) to 21 (95%) of the 22 criteria. No residents successfully met every pre-determined requirement.

Six of the criteria, including “symptoms” and “vital signs,” were included in the documentation by all 18 residents. Three additional criteria were met by at least 89% of residents.

Meanwhile, things that were consistently missed included documenting the patient’s history of prior reactions (28%) and all information in the “transfer-of-care" category (from 22% to 44%). The authors considered multiple reasons for these common missteps.

“This may reflect the infrequency with which radiology residents and practicing radiologists perform transfer-of-care tasks,” the authors wrote. “Alternatively, these documentation deficiencies may be secondary to gaps in training. Traditional training for radiology residents with regard to contrast agents has been focused on management skills, whereas transfer-of-care and documentation skills may be overlooked.”

According to the authors, this makes it clear that transfer-of-care criteria need to be a focus of radiologist resident education. In addition, they hope this issue receives more attention through additional research.

“Future studies should be performed to show the effectiveness of standardized documentation templates,” the authors wrote. “If shown to be effective, this approach should be adopted at the institutional level to improve patient safety and thorough reporting. There may be a need for the development of a universal standard, and national oversight bodies should play a role in this development.”