Radiological services in a hospital Emergency Department — an evaluation of service delivery and radiograph interpretation

Abstract

Radiological services to the Department of Ambulatory Paediatrics were audited over 1 month. Of a total of 782 separate radiographs, more than two‐thirds were performed outside hours when radiologists are normally in the hospital. For only 171 of the 782 radiographs (22%) were there immediate reports by a radiologist. To determine whether the absence of immediate radiologist reports affected clinical care, a process was introduced whereby radiologists reviewed interpretation of radiographs made by resident medical officers (RMO) when no report was available. Over a 5 month period 2888 patients had radiographs when there was no immediate radiologist's report. Comparisons were made between RMO interpretation and ultimate radiologist report in 1411 of these patients. In 232 cases (16.4%) there was a discrepancy between RMO interpretation and radiologist report; 70% of these were false positive (the RMO interpreting a normal film as abnormal) while 71 were false negative (the RMO interpreting an abnormal film as normal). This study demonstrates the utility of a relatively simple quality assurance measure in situations where clinical decisions have to be made in the absence of an immediate radiologist report.

How good are emergency department Senior House Officers at interpreting X-rays following radiographers?? triage?

“…In comparative terms, the results here are similar to those of previous studies [2][3][4][6][7][8][9]. For the combined system (red dot and SHO diagnosis), the FNR was 5.3% (4.0-6.9%) and the FPR was 8.9% (7.3-10.1%) (the denominator was taken to be the total number of X-rays).…”

“…A marked variation is found in the reported figures: for ED physicians, the false negative rates (FNRs) range from 0.5 to 5% [2,[4][5][6][7][8][9] and the false positive rates (FPRs) range from 1.2 to 11.4% [2]. Radiographers' diagnostic performance has also varied with FNR ranging from 4.5 to 4.6% [2,10] and FPR from 2.5 to 4.7% [2].…”

The impact of immediate reporting on interpretive discrepancies and patient referral pathways within the emergency department: a randomised controlled trial

“…Musculoskeletal (MSK) injuries account for over 60% of recorded ED primary diagnoses in England [2] and range from simple abrasions to amputations. Radiography plays an important role in the diagnosis of many of these injuries, with 22-50% of ED patients being referred for radiographie examination [3][4][5][6] and a smaller, but increasing, number of patients being referred directly for cross-sectional imaging, typically CT [7]. Importantly, these increasing demands for both ED and radiology services are occurring at the same time as healthcare organisations in the UK are being asked to evaluate the quality of care provided and constrain service costs.…”

Acute appendicitis and infectious mononucleosis.

“…Burkitt's lymphoma, another condition in which Epstein-Barr virus is implicated,2 also affects the appendix very rarely. 4 A 15 year old girl was admitted to hospital with a two day history of colicky abdominal pain, vomiting, and diarrhoea. Four days previously she had complained of sore throat; septic tonsillitis was diagnosed and treated with oral erythromycin.…”