Transcript The discrepancy rate between preliminary and official

M Itania, B Taslakiana, N. Batleyb, M. Salibab, E. Hittib, F El-Merhia
Departments of Radiologya and Emergency Medicineb
American University of Beirut Medical Center. Beirut, Lebanon
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Imaging studies are an essential tool in
emergency department (ED).
In many academic institutions, the radiology
resident provides preliminary reading for
emergency department.
The attending radiologist issues final reports
for these studies, and it might be concordant
or discordant.
Discrepancy rate between preliminary and official reports of
emergency radiology studies. Itani et al. ARC5 - April 2012
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The discrepancy between the preliminary
reading by radiology resident and the final
reading by the attending radiologist,
concerning studies requested by the
emergency department, vary in frequency and
severity. They may also vary between imaging
modalities, body parts, or resident level.
Discrepancy rate between preliminary and official reports of
emergency radiology studies. Itani et al. ARC5 - April 2012
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The aim of this paper is to estimate the rate
of discrepancy, study variable factors
associated with these discrepancies, and
benchmark it to other teaching institutions.
This has an implication on patient
management, performance of the hospital
according to international standards, and the
radiology residency training program.
This might also point out deficiencies and
thus allow for improvement.
Discrepancy rate between preliminary and official reports of
emergency radiology studies. Itani et al. ARC5 - April 2012
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All imaging studies from emergency
department are requested electronically, and
all images are sent to the picture archiving
and communication system (PACS) after
acquisition.
The medical staff in the emergency
department will be notified when a
preliminary or final report of the study has
been entered to the system.
Discrepancy rate between preliminary and official reports of
emergency radiology studies. Itani et al. ARC5 - April 2012
The radiology resident sends a preliminary
reading to emergency department, then
attending radiologist checks the imaging
studies. If there is a discrepancy in the
interpretation of the images, then two actions
will be taken:
1- The radiology resident will contact the
emergency department staff and notify them of
the discrepant finding. This will be entered into
a log book in the emergency department.
2- The study will be labeled by a keyword “A”.
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Discrepancy rate between preliminary and official reports of
emergency radiology studies. Itani et al. ARC5 - April 2012
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We reviewed the imaging studies performed
during a specific time period of 6 months
(June 1, 2011 to November 30, 2011).
We collected the total number of studies
performed on patients referred from the
emergency department. This was categorized
into plain radiography, ultrasound, and CT.
Discrepancy rate between preliminary and official reports of
emergency radiology studies. Itani et al. ARC5 - April 2012
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We then analyzed the discrepant studies,
collected from the emergency department log
book and the PACS system.
Each month, the discrepancy cases were
studied in a conjoint conference between
radiology and emergency departments staff,
and severity scale was assigned to each case.
Discrepancy rate between preliminary and official reports of
emergency radiology studies. Itani et al. ARC5 - April 2012
The severity score was assigned values of 1, 2
or 3 depending on how the discrepancy
affected the patient management, as follows:
1- major discrepancies that necessitated an
acute change in management and immediate
callback for the patient
2- significant findings that do not need urgent
intervention (can wait up to one day)
3- minor discrepancies that do not affect
management or outcome related to the
emergency presentation
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Discrepancy rate between preliminary and official reports of
emergency radiology studies. Itani et al. ARC5 - April 2012
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The cases were analyzed based on the
severity scores, the type of the exam
(musckuloskeletal x-rays, other plain
radiographs, ultrasound, CT), and according
to the level of the radiology resident intraining.
Discrepancy rate between preliminary and official reports of
emergency radiology studies. Itani et al. ARC5 - April 2012
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Graph 1: Total number of studies requested from
emergency department per month
1800
1600
1400
1200
1000
XRAY
800
CT
600
US
400
200
0
June
July
August
September
October
November
Discrepancy rate between preliminary and official reports of
emergency radiology studies. Itani et al. ARC5 - April 2012
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Graph 2: Number of discrepancies as percentage of
total studies requested from emergency department
171
examinatio
Number of discrepancies
ns
1.38%
Total Number of ED radiology
reports
12263
98.62%
Discrepancy rate between preliminary and official reports of
emergency radiology studies. Itani et al. ARC5 - April 2012
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Graph 3: Number of studies requested
through emergency department 12263
divided as follows
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3.55%
3242
26.49%
XRAY
8561
69.96%
CT
US
Discrepancy rate between preliminary and official reports of
emergency radiology studies. Itani et al. ARC5 - April 2012
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Graph 4: Percentages of discrepancies
according to imaging modality
0.58%
33.92%
X-ray MSK
47.95%
X-ray Non-MSK
CT
US
17.54%
Discrepancy rate between preliminary and official reports of
emergency radiology studies. Itani et al. ARC5 - April 2012
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Graph 5: Discrepancy rate per resident level
2.00%
1.80%
1.60%
1.40%
1.20%
1.00%
0.80%
0.60%
0.40%
0.20%
0.00%
R1
R2
R3
R4
Discrepancy rate between preliminary and official reports of
emergency radiology studies. Itani et al. ARC5 - April 2012
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Graph 6: Discrepancy rate per modality of
imaging
1.80%
1.60%
1.40%
1.20%
1.00%
0.80%
0.60%
0.40%
0.20%
0.00%
X-ray
CT
US
Discrepancy rate between preliminary and official reports of
emergency radiology studies. Itani et al. ARC5 - April 2012
Graph 7: Number of discrepancies for each
severity score
70
Number of discrepancies
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60
50
40
30
20
10
0
1
2
3
Severity Score
Discrepancy rate between preliminary and official reports of
emergency radiology studies. Itani et al. ARC5 - April 2012
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Studies comparing resident-to-attending
discrepancy had values of 4.3% from
Northwestern University Feinberg School of
Medicine, 2.6 % from Monmouth Medical
Center, and 3.8% from Robert Wood Johnson
University Hospital.
The total discrepancy rate was1.38% , which
is below the international standards.
Discrepancy rate between preliminary and official reports of
emergency radiology studies. Itani et al. ARC5 - April 2012
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According to RADPEER data published in
2009 by the American College of Radiology
for attending-to-attending variability in
interpretations, the total disagreement rate
was 2.91%
Discrepancy rate between preliminary and official reports of
emergency radiology studies. Itani et al. ARC5 - April 2012
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It is expected to have higher discrepancy rate
in CT and X-ray than ultrasound since
ultrasound is operator dependent.
Having lower discrepancy rate for lower level
residents may be related to the fact that more
difficult or controversial studies are being
interpreted by more senior residents.
Discrepancy rate between preliminary and official reports of
emergency radiology studies. Itani et al. ARC5 - April 2012
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The discrepancy rate of radiology reports for
emergency department should be monitored
for performance evaluation and improvement
of systems for clinical and academic
accreditation purposes.
Discrepancy rate between preliminary and official reports of
emergency radiology studies. Itani et al. ARC5 - April 2012
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We give an example of a discrepancy
monitoring system and display the results in
a leading academic medical institution in the
Middle East. We hope that this “Performance
Indicator (PI)” becomes more systematically
integrated in other Arab Academic
Institutions.
Discrepancy rate between preliminary and official reports of
emergency radiology studies. Itani et al. ARC5 - April 2012