A Multiobserver Study of the Effects of Including Point-of-care Patient Photographs with Portable Radiography

Rationale and Objectives

To evaluate whether the presence of facial photographs obtained at the point-of-care of portable radiography leads to increased detection of wrong-patient errors.

Materials and Methods

In this institutional review board–approved study, 166 radiograph–photograph combinations were obtained from 30 patients. Consecutive radiographs from the same patients resulted in 83 unique pairs (ie, a new radiograph and prior, comparison radiograph) for interpretation. To simulate wrong-patient errors, mismatched pairs were generated by pairing radiographs from different patients chosen randomly from the sample. Ninety radiologists each interpreted a unique randomly chosen set of 10 radiographic pairs, containing up to 10% mismatches (ie, error pairs). Radiologists were randomly assigned to interpret radiographs with or without photographs. The number of mismatches was identified, and interpretation times were recorded.

Results

Ninety radiologists with 21 ± 10 (mean ± standard deviation) years of experience were recruited to participate in this observer study. With the introduction of photographs, the proportion of errors detected increased from 31% (9 of 29) to 77% (23 of 30; P = .006). The odds ratio for detection of error with photographs to detection without photographs was 7.3 (95% confidence interval: 2.29–23.18). Observer qualifications, training, or practice in cardiothoracic radiology did not influence sensitivity for error detection. There is no significant difference in interpretation time for studies without photographs and those with photographs (60 ± 22 vs. 61 ± 25 seconds; P = .77).

Conclusions

In this observer study, facial photographs obtained simultaneously with portable chest radiographs increased the identification of any wrong-patient errors, without substantial increase in interpretation time. This technique offers a potential means to increase patient safety through correct patient identification.

The Institute of Medicine’s Quality Report estimates that nearly 98,000 deaths annually may be attributed to medical errors . Within radiology, an important source of error is the wrong-patient error , wherein one patient’s imaging study may be placed in another patient’s folder in a picture archiving and communication system (PACS). Such errors can create problems for both the involved patients. In fact, the National Quality Forum recognizes that wrong-patient errors can affect radiologic practice and that agency, along with the Agency for Healthcare Research and Quality, specifically endorses implementation of a “standardized protocol to prevent mislabeling of radiographs” .

Based on a statewide adverse event reporting system, the Pennsylvania Patient Safety Authority published that, in 2009, it received 652 reports on radiology events: 196 (30.1%) of these reported events were related to wrong-patient events. Of these 196 wrong-patient events, 93 (47%) occurred in the imaging modality of radiography. The report concluded that such errors “occur more frequently than health care providers and patients may realize” despite various quality improvement measures .

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Materials and methods

Study Population

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Data Acquisition and Case Selection

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Display Workstation Environment

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Observer Study Design

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Statistical Analysis

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Results

Observer Characteristics

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Table 1

Observer Characteristics

Characteristic Value without Photos ( n = 45) Value with Photos ( n = 45) Total ( n = 90) Age (years) ∗ 53 ± 10 (35, 83) 53 ± 9 (37, 82) 53 ± 10 (35–83) Gender † Male 27 29 56 (62) Female 18 16 34 (38) Years postresidency training ∗ 22 ± 10(4, 52) 20 ± 10 (6, 50) 21 ± 10 (4–52) Fellowship training † Yes 38 38 76 (84) No 7 7 14 (16) Fellowship subspecialty † Abdominal 11 5 16 (18) Breast 2 4 6 (7) Cardiothoracic 7 9 16 (18) Interventional 5 5 10 (11) Musculoskeletal 2 5 7 (8) Neuroradiology 2 2 4 (4) Nuclear medicine 2 3 5 (6) Pediatric 4 5 9 (10) Other 3 1 4 (4) Not applicable 7 6 13 (14) Current subspecialty practice † Abdominal 11 6 17 (19) Breast 8 7 15 (17) Cardiothoracic 9 9 18 (20) Interventional 4 5 9 (10) Musculoskeletal 3 7 10 (11) Neuroradiology 2 2 4 (4) Nuclear Medicine 2 2 4 (4) Pediatric 3 6 9 (10) General radiology 3 1 4 (4)

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Qualitative Results Examples

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Quantitative Results

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Table 2

Likelihood of Detecting a Wrong-patient Error: All Radiologists

Characteristic Without Photos With Photos Radiologists unexposed to wrong-patient error ( n = 31) 0/16 (0) 0/15 (0) Radiologists exposed to wrong-patient error ( n = 59) 9/29 (31) 23/30 (77)

Data are presented as ratio of errors detected to number of observers in each category and percent in parentheses.

Table 3

Likelihood of Detecting Wrong-patient Error by Radiologist Characteristics

Characteristic Without Photos Errors detected ∗ With Photos Errors Detected Odds Ratio † P Value ‡ Total readers ( n = 59) 9/29 (31) 23/30 (77) 7.30 (2.29–23.18) 0.006 Current subspecialty Cardiothoracic ( n = 12) 1/5 (20) 6/7 (86) 24 (1.14–505.19) 0.072 Noncardiothoracic ( n = 47) 8/24 (33) 17/23 (74) 5.67 (1.61–19.99) 0.008 Portable chest radiograph interpretation Specialties with current expertise in chest radiography ( n = 36) § 6/18 (33) 14/18 (78) 7 (1.5–30.80) 0.017 Specialties without current expertise in chest radiography ( n = 23) ‖ 3/11 (27) 9/12 (75) 8 (1.24–51.50) 0.039 Experience level >10 year postresidency ( n = 50) 8/25 (32) 20/25 (80) 8.5 (2.34–30.98) 0.014 ≤10 year postresidency ( n = 9) 1/4 (25) 3/5 (60) 4.5 (0.25–80.56) 0.524 Fellowship subspecialty Cardiothoracic ( n = 10) 1/3 (33) 7/10 (86) 12 (0.49–294.55) 0.183 Noncardiothoracic ( n = 49) 8/26 (31) 17/23 (74) 6.38 (1.83–22.23) 0.004 Fellowship trained Yes ( n = 51) 8/25 (32) 21/26 (81) 8.93 (2.46–32.33) 0.006 No ( n = 8) 1/4 (25) 2/4 (50) 3 (0.15–59.89) 1.000

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Poststudy Questionnaire

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Table 4

Results of Questionnaire That Observers Who Interpreted Studies with Photographs Completed at the End of Their Interpretation Session ∗

Question Response Yes No 1) Were the photographs a distraction? 8 (20) 31 (80) 2) Did you feel you spent more time because of the photographs? 18 (42) 25 (58) 3) Did the photographs help with the interpretation? 19 (44) 24 (56) 4) If you noted mismatched photographs, did you go back and check the radiographs? † 22 (96) 1 (4)

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Discussion

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Relationship to Prior Studies

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Study Limitations

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Conclusions

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Acknowledgments

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References

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2. National Quality Forum. 30 Safe practices for better health care fact sheet. Available at: http://www.ahrq.gov/qual/30safe.htm . Accessed June 23, 2012.
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A Multiobserver Study of the Effects of Including Point-of-care Patient Photographs with Portable Radiography

Rationale and Objectives

Materials and Methods

Results

Conclusions

Materials and methods

Study Population

Data Acquisition and Case Selection

Display Workstation Environment

Observer Study Design

Statistical Analysis

Results

Observer Characteristics

Qualitative Results Examples

Quantitative Results

Poststudy Questionnaire

Discussion

Relationship to Prior Studies

Study Limitations

Conclusions

Acknowledgments

References

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