Introduction

This guidance – developed with, and supported by, The Royal College of Radiologists (RCR) and The Society of Radiographers – sets out a clear approach for NHS trusts to automatically release verified imaging reports directly and digitally to patients. It is primarily directed at NHS trust operational, imaging and digital staff. The approach of directly informing patients digitally of their imaging results empowers patients access to their health records and acts as a failsafe process should standard communication processes be delayed or missed.

It does not supersede previous guidance on direct communication to patients and referrers, as set out in the Academy of Medical Royal Colleges’ (AOMRC; October 2022) Alerts and notification of imaging reports – recommendations, and this approach for radiological results may be adopted for other diagnostics.

In 2019, the Healthcare Safety Investigation Branch (HSIB) report Failures in communication or follow-up of unexpected significant radiological findings recommended a digital method for notifying patients of unexpected significant findings in an agreed timeframe. Our recently published (July 2024) Results release clinical standards built on this recommendation, stating that all test results should be released via a digital route, where possible.

Digitally sharing imaging results with all patients improves overall access to healthcare data, beyond those with unexpected and significant findings.

Principles for communicating results to patients

As set out in our Standards for the communication of patient diagnostic test results on discharge from hospital, the guiding principles for communicating results to patients are:

• the referrer who initiates the test is responsible for reviewing, acting on and communicating the result
• a universal disclaimer is to be added to all reports released directly to the patient:

“This report has been sent to the referring clinician (doctor or other healthcare professional) who referred you for this investigation. If you have any questions, please discuss with your referring clinician.”

• the imaging report is a medical opinion and so will contain medical phrases and terminology. RCR is working to recommend adjustments to imaging reports in light of greater patient access, and the report may include a footnote to this effect

Approach and timeline for releasing imaging results to patients

We recommend that digital imaging reports are automatically made available to patients 4 weeks after they have been formally verified on the Radiology Information System (RIS) or an equivalent system. These should be released to patients via the NHS App and/or other agreed digital channels such as local patient engagement portals (PEPs).

Setting the embargo on sharing results with patients at 4 weeks mitigates the risk of their receiving results of initial diagnostic imaging examinations before a final diagnosis is complete. This will require the referrer to action urgent test results and ensure there has been follow-up communication with the patient ahead of the report being shared directly with the patient.

Automatically sending the verified imaging report directly to the patient after a 4-week period acts as a failsafe should standard communication processes fail.

If a trust is already sharing verified results with patients within a timeframe shorter than 4 weeks, we do not expect it to adjust its timeframe to align with this guidance.

A more ambitious target – for example, releasing reports 2 weeks after formal verification – should be considered within 12–24 months of the go-live date, with the agreement of the national teams involved and once clinicians have embedded the practice from the initial rollout.

Digital access

The planned solution for patients with digital access is the NHS App/PEPs as the primary digital channel for access to their imaging results.

For patients without digital access, the existing local non-digital communication process should be followed.

Patients with unexpected findings will be contacted by the referrer before the 4-week digital results release.

These processes should align with the recommendations in the AOMRC’s alerts and notification of imaging reports, to ensure that patients are first informed of their report/results by the referrer.  

Digital report acknowledgement by the referrer

The imaging department issues verified imaging reports to the referring clinician. The referrer is expected to acknowledge receipt and ensure all unsuspected/critical findings are communicated urgently to their patients, following locally agreed standard operating procedures that align with the AOMRC’s Alerts and notification of imaging reports.

Related publications

• NPSA Safety alert 16: Early identification of failure to act on radiological imaging reports, National Patient Safety Agency (2007)
• Diagnostic imaging reporting turnaround times, NHS England (Aug 2023)
• Recommendations on alerts and notification of imaging reports, The Royal College of Radiologists (2016)
• Unlocking solutions in imaging: working together to learn from failings in the NHS, Parliamentary and Health Service Ombudsman (July 2021)
• Failures in communication or follow-up of unexpected significant radiological findings, Healthcare Safety Investigation Branch (2019)

Publication reference: PRN01543