How would you communicate a critical finding when the referring clinician is unavailable?

Instruction: Give the urgent phone call you would make, then explain how you would confirm that somebody has taken responsibility for the patient.

Context: An outpatient CT angiogram shows a definite ascending aortic dissection. You confirm the finding on the source images. The patient has already left; the department recorded ongoing chest pain before departure. The referring clinician is unreachable, but the emergency department has an on-duty senior clinician.

Updated

Example Answer

I would call the emergency department senior immediately while a colleague establishes the patient’s current location. My opening would be: “This is the reporting radiologist. I have a critical result for the patient whose identifiers we have just confirmed: an ascending aortic dissection. They left after this outpatient scan and had ongoing chest pain. They need emergency assessment. Can you take responsibility for arranging immediate contact and emergency transport?”

I would check that the recipient understood the finding and agree who is contacting the patient and the relevant emergency specialist team. I would send the images and report promptly, but I would not wait for polished wording before making that call. If the first recipient could not accept responsibility, I would continue through the emergency escalation route. My record would name the clinician, time, acknowledged result, and agreed action; an unanswered call or electronic alert would remain an open task.

What the interviewer is assessing

An effective answer gives the actual message: verified identity, definite finding, patient location, urgency, and an explicit request for an accountable clinical response. The radiologist must close the communication loop while the emergency team organizes clinical management.

Red flags: Waiting for the original referrer, treating a sent alert as acknowledgment, or asking a symptomatic patient to drive themselves without an emergency transport plan.

Follow-up

What if the duty clinician says they cannot locate the patient and suggests leaving a voicemail?

I would ask them to activate the local urgent patient-contact and emergency-response process with me. A voicemail may be one attempt, but it does not resolve the risk. I would document the unsuccessful contacts and keep escalating until a responsible clinician or emergency service has accepted the next action.

Clinical reference: RCR alerts and notification recommendations.

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