Radiographic imaging for traumatic ankle injuries: a demand profile and investigation of radiological reporting timeframes from an Australian tertiary facility

Abstract

BackgroundRadiographic examinations of the ankle are important in the clinical management of ankle injuries in hospital emergency departments. National (Australian) Emergency Access Targets (NEAT) stipulate that 90 percent of presentations should leave the emergency department within 4 hours. For a radiological report to have clinical usefulness and relevance to clinical teams treating patients with ankle injuries in emergency departments, the report would need to be prepared and available to the clinical team within the NEAT 4 hour timeframe; before the patient has left the emergency department. However, little is known about the demand profile of ankle injuries requiring radiographic examination or time until radiological reports are available for this clinical group in Australian public hospital emergency settings.MethodsThis study utilised a prospective cohort of consecutive cases of ankle examinations from patients (n = 437) with suspected traumatic ankle injuries presenting to the emergency department of a tertiary hospital facility. Time stamps from the hospital Picture Archiving and Communication System were used to record the timing of three processing milestones for each patient’s radiographic examination; the time of image acquisition, time of a provisional radiological report being made available for viewing by referring clinical teams, and time of final verification of radiological report.ResultsRadiological reports and all three time stamps were available for 431 (98.6%) cases and were included in analysis. The total time between image acquisition and final radiological report verification exceeded 4 hours for 404 (92.5%) cases. The peak demand for radiographic examination of ankles was on weekend days, and in the afternoon and evening. The majority of examinations were provisionally reported and verified during weekday daytime shift hours.ConclusionsProvisional or final radiological reports were frequently not available within 4 hours of image acquisition among this sample. Effective and cost-efficient strategies to improve the support provided to referring clinical teams from medical imaging departments may enhance emergency care interventions for people presenting to emergency departments with ankle injuries; particularly those with imaging findings that may be challenging for junior clinical staff to interpret without a definitive radiological report.

Evaluating the effectiveness of intensive versus non‐intensive image interpretation education for radiographers: a randomised control trial study protocol

“…Access to appropriate and timely medical imaging is important for the provision of effective emergency healthcare in hospital settings . Findings from medical imaging investigations underpin many diagnostic and treatment decisions, particularly for people who have presented to hospital following a trauma event.…”

“…In emergency settings, the definitive radiology report may not be available within a clinically relevant timeframe . This means that treatment decisions are likely to have been implemented by the referring clinical team before the radiologist's report is available in many cases.…”

“…This means that treatment decisions are likely to have been implemented by the referring clinical team before the radiologist's report is available in many cases. Unfortunately, delay between radiographic image capture and the availability of the radiologist's report can contribute to missed, incomplete or incorrect diagnoses . One approach to mitigate risk and better support junior or inexperienced members of the referring clinical team is the recording of a brief comment by the radiographer at the time of image capture to highlight any abnormalities they may have detected …”

“…Access to appropriate and timely medical imaging is important for the provision of effective emergency healthcare in hospital settings. 1,2 Findings from medical imaging investigations underpin many diagnostic and treatment decisions, particularly for people who have presented to hospital following a trauma event. Even with the rise in use of computed tomography since its development in 1972, 3,4 radiographic image series remains the primary imaging modality requested for patients who may have sustained trauma.…”

“…5 In emergency settings, the definitive radiology report may not be available within a clinically relevant timeframe. 2 This means that treatment decisions are likely to have been implemented by the referring clinical team before the radiologist's report is available in many cases. Unfortunately, delay between radiographic image capture and the availability of the radiologist's report can contribute to missed, incomplete or incorrect diagnoses.…”