The discrepancy rate between preliminary and official reports of emergency radiology studies: a performance indicator and quality improvement method

Abstract

Background: At teaching hospitals, radiology residents give preliminary reports for imaging studies requested from the Emergency Department (ED). Discrepancy rates between preliminary and final reports represent an important performance indicator.

Purpose: To present a system for feedback and follow-up of discrepancies, identify the variables associated with the rate and severity of such discrepancies, target the weaknesses, and suggest the need of a standard reference value for comparison among institutions.

Material and methods: A monitoring and communication system between the Department of Diagnostic Radiology and Emergency Department was initiated to mark and follow all studies from the ED for which the official reading was different than the preliminary interpretation. Data analysis was performed on all studies from 1 June 2011 to 31 May 2012, based on the severity of the discrepancy, imaging modality, resident training level, and organ system. The distribution of the number of discrepancies among the different resident levels and imaging modalities was determined, as well as the distribution of three severity scores in correlation with other variables.

Results: The overall discrepancy rate was 1.62%. The discrepancy rate was higher for first and second year residents (1.62% and 1.96%) than for third and fourth year residents (1.35% and 1.24%). It was higher for computed tomography (2.13%) than for radiographs (1.29%) and ultrasound (0.8%) (P value < 0.01), and higher for musculoskeletal (1.61%) than non-musculoskeletal (0.99%) radiographs (P value = 0.0003). Discrepancies with severity score one constituted 35.5% of the total discrepancies, those with severity scores two and three constituted 22.9% and 41.6%, respectively.

Conclusion: We have demonstrated a system for follow-up of discrepancy in interpreting emergency radiology studies, and recorded the discrepancy rate, with further analysis based on different variables. In terms of quality assurance, a periodical analysis might help to reduce the number of discrepant reports by targeted intervention.

Keywords: Diagnostic imaging; discrepancy; emergency radiology; misdiagnosis; preliminary report; resident reporting.