Efficacy of a Checklist-Style Structured Radiology Reporting Template in Reducing Resident Misses on Cervical Spine Computed Tomography Examinations

Abstract

The increasing use of medical checklists to promote patient safety raises the question of their utility in diagnostic radiology. This study evaluates the efficacy of a checkliststyle reporting template in reducing resident misses on cervical spine CT examinations. A checklist-style reporting template for cervical spine CTs was created at our institution and mandated for resident preliminary reports. Ten months after implementation of the template, we performed a retrospective cohort study comparing rates of emergent pathology missed on reports generated with and without the checklist-style reporting template. In 1,832 reports generated without using the checklist-style template, 25 (17.6 %) out of 142 emergent findings were missed. In 1,081 reports generated using the checklist-style template, 13 (11.9 %) out of 109 emergent findings were missed. The decrease in missed pathology was not statistically significant (p=0.21). However, larger differences were noted in the detection of emergent non-fracture findings, with 17 (28.3 %) out of 60 findings missed on reports without use of the checklist template and 5 (9.3 %) out of 54 findings missed on reports using the checklist template, representing a statistically significant decrease in missed non-fracture findings (p = 0.01). The use of a checklist-style structured reporting template resulted in a statistically significant decrease in missed non-fracture findings on cervical spine CTs. The lack of statistically significant change in missed fractures was expected given that residents' search patterns naturally include fracture detection. Our findings suggest that the use of checklists in structured reporting may increase diagnostic accuracy.

Structured Radiology Reporting: Addressing the Communication Quality Gap

“…Lack of information in radiology reports is not restricted to cancer imaging. Similar problems with lack of information have been identified, for example, in lumbar spine imaging [41], multiple sclerosis MRI [42], and cervical spine CT [43].…”

“…Structured reporting can lead to an increase in quality of reports, higher reproducibility and standardization, increased productivity of the department, better satisfaction of referring physicians, fewer inquiries on report content, and a huge number of data from the possibility to analyze the report content [17,18,43,78,79]. The latter has further consequences for better exploitation of routine data for the gain of new knowledge in the medical field.…”

Adding Value as Young Radiologists: Challenges and Opportunities, Part 1

“…In addition to patient care, these reports are commonly components of educational, research, legal, and billing purposes. The use of structured reporting has been shown to improve image interpretation and surgical planning compared with nonstructured reports [20][21][22]. However, multiple studies indicate that radiology report guidelines and templates insufficiently address clear objectives and implementation issues [18,19,23].…”

Contextual Radiology Reporting: A New Approach to Neuroradiology Structured Templates

“…Last, contextual templates that emphasize a systematic approach to interpretation can help mitigate the cognitive bias of "satisfaction of search." 30 This error occurs when a radiologist identifies a finding and overlooks additional findings due to complacency. Contextual reporting will remind the user to look at all described entities regardless of whether 1 finding is already identified.…”