Optimizing closed loop communication of critical test results is a national patient safety goal. A four‐year quality improvement initiative lead by the CEBI team beginning in 2006 demonstrated substantial improvements in closed loop communication of critical results. Several private foundation grants from CRICO‐Risk Management Foundation as well as AHRQ, funded the design, implementation and evaluation of a public domain software application, Alert Notification of Critical Results (ANCR), to automate creation, notification, escalation, and audit of critical alerts16,17. Between 8% to 9% of radiology reports at BWH contain a critical result. Some 50,000 critical results are generated annually in radiology, cardiology, and pathology using ANCR and >98% are acknowledged by providers within the required parameters of the BWH policy for communication of critical results18.