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Objective:
It is estimated that over one-third of communication errors within radiology workflow are associated with a direct negative impact on patient care and it is the third most prevalent cause of malpractice cases in the US. At the Ottawa Hospital, the Radiology Critical Results Communication Workflow was implemented in 2019 to ensure prompt and bidirectional communication of critical results to the corresponding health providers. The primary purpose of the study was to review workflow utilization and compliance over time, especially during the period after the educational intervention.

Materials and Methods:
The study took place at the Ottawa Hospital, tertiary academic hospital that provides care to 55,000 in-patients and 150,000 emergency visits annually. We examined all critical results from June 2019 to June 2022, reviewing the number of the critical result reports, compliance of radiologists and physicians to workflow policy, and time to communication closure over time. Further analysis included investigation of the impact of educational initiative and tweaking in the technical workflow that took place in June 2021 to enforce workflow adoption as part of the physician’s regular practice.

Results:
Workflow utilization change year-over-year increased by 65% (p < 0.05) between years 1 to 2 but decreased by 22.6% (p < 0.05) between years 2 to 3. Meanwhile, workflow utilization among physicians who worked across all three years showed a strong correlation (n = 27) between years of usage and frequency of utilization (tb = .543, p < .05). Compliance also improved over time across all acuity levels - critical, significant, and unexpected, especially after the educational initiative. Finally, we examined improvement in workflow compliance across different imaging modalities before and after the educational initiative. Findings suggest a general improvement in workflow compliance, most notably in the CT imaging group. There was a significant relationship between CT and compliance, X2 (5, n = 1861) = 108.96, p < 0.05. The effect size for this finding, Cramer’s V, was moderate at 0.33.

Conclusion:
Our findings suggest passive and active education initiatives have an important role in increasing policy adaptation. The passive approach focuses on providing the necessary resources and time for physicians to learn and familiarize themselves with the policy, whereas the active approach prioritizes targeting specific groups of physicians to engage in continuous learning. In addition, there is also a need to take precautionary measures to reduce over-reporting and to prevent alert fatigue for physicians. In conclusion, while the policy implementation is a challenging and evolving process, the implementation of the workflow at the Ottawa Hospital has significantly improved workflow, patient care and decreased medicolegal liabilities.