A Multiobserver Study of the Effects of Including Point-of-care Patient Photographs with Portable Radiography

Abstract

Objectives To evaluate whether the presence of facial photographs obtained at the point-of-care of portable radiography leads to increased detection of wrong-patient errors. Materials and Methods In this IRB-approved study, 166 radiograph-photograph combinations were obtained from 30 patients. Consecutive radiographs from the same patients resulted in 83 unique pairs (i.e., a new radiograph and prior, comparison radiograph) for interpretation. To simulate wrong-patient errors, mismatched pairs were generated by pairing radiographs from different patients chosen randomly from the sample. Ninety radiologists each interpreted a unique randomly chosen set of 10 radiographic pairs, containing up to 10% mismatches (i.e., error pairs). Radiologists were randomly assigned to interpret radiographs with or without photographs. The number of mismatches identified and interpretation times were recorded. Results Ninety radiologists with 21 ± 10 (mean ± SD) years of experience were recruited to participate in this observer study. With the introduction of photographs, the proportion of errors detected increased from 31% (9/29) to 77% (23/30) (P = 0.006). The odds ratio for detection of error with photographs to detection without photographs was 7.3 (95% CI: 2.29, 23.18). Observer qualifications, training or practice in cardiothoracic radiology did not influence sensitivity for error detection. There is no significant difference in interpretation time for studies without photographs and those with photographs (60 ± 22 seconds vs 61 ± 25 seconds; P=0.77). Conclusion In this observer study, facial photographs obtained simultaneously with portable chest radiographs increased the identification of any wrong-patient errors, without substantial increase in interpretation time. This technique offers a potential means to increase patient safety through correct patient identification.

Stakeholders’ Perceptions Regarding the Use of Patient Photographs Integrated with Medical Imaging Studies

“…However, prior observer studies on integrating photographic IDs with imaging had demonstrated minimal potential impact on interpretation times [7,8,16]. Additionally, 33 % of radiologists in the current study believed that photographic IDs might be distracting.…”

“…Including patients' photos in EMR in an order verification screen prior to final signing of orders is an effective strategy for reducing the risk that medication orders will be placed in an unintended patient's EMR [14]. In radiology, observer studies demonstrated that facial photographs obtained at the time of portable chest radiographs increase detection rate of wrong-patient errors [7,8]. Other small studies (sample size of less than 50) assessing the impact of having patients' photographs available at the time of radiologists' interpretation of imaging showed no significant difference in the presence and number of clinically significant findings, when compared to studies without attached patient's photographs [15].…”

“…Integrating patients' digital facial photographs as identifiers (ID) with medical imaging (integrated photographic ID) [6] (Fig. 1) has been shown to increase the detection of mislabeled studies in adults [7,8]. Such photographs will not replace numerical identifiers, but rather supplement and strengthen identification.…”

A Novel Technology for Automatically Obtaining Digital Facial Photographs Near-Simultaneously with Portable Radiographs

“…To increase the detection rate of wrong-patient errors in portable radiography, we have developed a technology that automatically obtains point-of-care patient photographs and, using the combined radiographic Plate_ID and time stamp, ensures that the photograph and radiograph are tightly coupled in the PACS. When radiologists or other interpreting physicians view these photographs along with the corresponding radiographs in comparison with prior studies (which also contain photographs), any wrong-patient error would become obvious [4,5]. If there are no prior studies with photographs, then a comparison could be made between the photograph in the current imaging study and photographs in the patient's EMR.…”

“…Subsequently, through observer studies [4,5], we demonstrated that the addition of photographs to portable radiographs could significantly increase the detection rate of simulated wrong-patient errors. Note that our scheme will not prevent wrong-patient errors at the image acquisition level; rather, it is expected to lead to increased detection of such errors at the interpretation stage, thus resulting in decreased wrong-patient radiology reports.…”