Event Documentation and Transfer of Care After Severe Contrast Reactions

Abstract

Purpose: Radiology residencies are increasingly using clinical simulation to teach contrast reaction management. The aim of this study was to evaluate resident documentation of management and transfer of care in severe contrast reactions after a clinical simulation.

Methods: After a high-fidelity mannequin simulation of contrast-induced anaphylactic shock, residents (n = 18) were asked to document the event in a progress note and transfer care to a receiving medical team. A total of 22 prospectively determined criteria were selected, and notes were analyzed by a blinded reviewer.

Results: Notes contained between 12 and 21 of the prospectively determined 22 criteria (54%-95%). The median number of criteria contained in a note was 16. None of the notes fulfilled all 22 criteria. However, consistent deficiencies were found in documenting prior reaction to contrast (28%) and transfer-of-care criteria (22%-44%).

Conclusions: Although standards for the documentation of advanced cardiovascular life support codes and other emergencies have been devised, no such standards exist for documentation in the management of contrast reactions. The results of this study suggest the need to develop a standardized documentation system for severe contrast-induced reactions. Education regarding transfer of care and documentation should be emphasized during clinical simulation.

Keywords: Contrast reaction; simulation; transfer of care.