Reducing errors in the accident department: a simple method using radiographers.

Abstract

The assessments by radiographers of 1628 consecutive patients referred for radiography in the casualty department were analysed. The radiographers missed abnormalities in the radiographs in 68 of the cases. Casualty officers missed abnormalities in 63 cases, but only 35 patients were common to both groups. Twenty eight of the radiographs interpreted wrongly by casualty officers were interpreted correctly by radiographers; 16 of these 28 were thought by the accident and emergency consultant to be clinically important.It is suggested that a system whereby radiographers signal abnormalities should be standard practice.

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].…”

“…As a result, the 'red dot system' [2], involving the radiographers' triaging of X-rays into abnormal and normal before interpretation by an emergency physician, has been introduced. This two-staged process operates in around 85% of EDs in the UK [3].…”

“…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 denominator was taken to be the total number of X-rays in each study.…”

The missed extremity fractures in emergency department

“…Radiology departments should give priority to reporting ED films and the best solution is to have an immediate reporting system. Marking of abnormal radiographs by radiographers can assist in reducing diagnostic errors [17] but the value of this may be limited by a high rate of false positives. [18] Few EDs have a full-time radiologist on duty 24 hours a day.…”