Rational and Objectives
The increasing importance of imaging for both diagnosis and management in patient care has resulted in a demand for radiology services 7 days a week, 24 hours a day, especially in the emergency department (ED). We hypothesized the resident preliminary reports were better than generalist radiology interpretations, although inferior to subspecialty interpretations.
Materials and Methods
Total radiology volume through our Level I pediatric and adult academic trauma ED was obtained from the radiology information system. We conducted a literature search for error and discordant rates between radiologists of varying experience. For a 2-week prospective period, all preliminary reports generated by the residents and final interpretations were collected. Significant changes in the report were tabulated.
Results
The ED requested 72,886 imaging studies in 2004 (16% of the total radiology department volume). In a 2-week period, 12 of 1929 (0.6%) preliminary reports by residents were discordant to the final subspecialty dictation. In the 15 peer-reviewed publications documenting error rates in radiology, the error rate between American Board of Radiology (ABR)−certified radiologists is greater than that between residents and subspecialists in the literature and in our study. However, the perceived error rate by clinicians outside radiology is significantly higher.
Conclusion
Sixteen percent of the volume of imaging studies comes through the ED. The residents handle off-hours cases with a radiology-detected error rate below the error rate between ABR-certified radiologists. To decrease the perceived clinician-identified error rate, we need to change how academic radiology handles ED cases.
Technological improvements have made imaging essential for patient diagnosis and management. Physicians routinely review imaging studies, especially CT and MR studies, before examining the patient. Nowhere is this more apparent than the emergency department (ED). The physical examination is secondary in many disciplines. Most imaging studies are interpreted during regular office hours, but the need to care for ED patients in a timely fashion demands expedited processing by radiology all hours of the day and all days of the week.
At the time of the study, there was no separate ED radiology division in our academic university health system. Interpretation strategies varied by the day and shift. A radiology junior resident is always present in the ED to review ongoing plain radiographic examinations. During regular working hours, subspecialty faculty interpret the majority of the plain radiographic cases in the radiology reading area in the ED with this resident. Subspecialty faculty during regular working hours interpret cross-sectional imaging studies from a remote location on a PACS.
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Materials and methods
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Results
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Table 1
Distribution of Most Common Imaging Studies Requested Through the ED in 2004
Imaging Study Volume % of Total Plain radiography 47,877 65.7 CT 15,578 21.4 US 4373 6 MRI 947 1.3 Consultations 1020 1.4 Other (GI, GU, angiography, etc.) 3061 4.2 Total 72,886 100
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Table 2
Distribution of Discordant Preliminary Reports
Imaging Study Volume Consensus Discrepant Reports % of Total Plain radiography 934 0 0 Nuclear medicine 41 1 2.4 Adult US 118 0 0 MRI 1 0 0 Neuroradiology 398 3 0.8 Pediatric CT and US 58 0 0 Adult abdomen CT 327 8 2.4 Adult chest CT 52 0 0 Total 1929 12 0.6
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Discussion
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Conclusion
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