Liza Gergenti1, Robert P Olympia2. 1. Penn State College of Medicine, 500 University Drive, Hershey, PA 17033, USA. Electronic address: lgergenti@pennstatehealth.psu.edu. 2. Department of Emergency Medicine, Department of Pediatrics, Penn State Hershey Medical Center, 500 University Drive, Hershey, PA 17033, USA. Electronic address: rolympia@hmc.psu.edu.
Abstract
BACKGROUND: Diagnostic errors made by radiology resident physicians may lead to significant morbidity/mortality and patient dissatisfaction. OBJECTIVE: To determine the etiology and disposition associated with radiology discrepancies on emergency department (ED) patients. METHODS: We conducted a retrospective electronic chart review of patients presenting to our ED during "off hours" at the Penn State Hershey Medical Center during October 2013-November 2014 and had a radiology discrepancy, defined as a patient discharged from the ED with a diagnostic interpretation disagreement between the initial radiology resident physician read and final radiology attending physician read. RESULTS: 81,201 images were performed during "off hours", with 174 radiology discrepancies (0.214%) identified. Most discrepancies were associated with CT scans (62%). The most common final diagnostic interpretations associated with discrepancies were missed fracture (10.9%), incidental findings of mass or cyst (10.3%), gastrointestinal inflammation (6.3%), and pneumonia (5.7%). 10% of radiology discrepancies were instructed to emergently return to the ED. The most common modality associated with ED follow-up was CT scan of the abdomen/pelvis (50%). Of the 17 patients that returned to the ED, 10 had additional diagnostic imaging, 9 received a subspecialist consult, 5 required surgical treatment, 5 required additional medications, and 1 required a medical hospitalization. CONCLUSIONS: Based on our sample, discrepancies were a small percentage of images performed during "off hours", and were associated with CT scans, missed fractures, and non-emergent outpatient follow-up. We suggest that ED and radiology departments work collaboratively to monitor their own rates of discrepancies, and subsequent morbidities and mortalities, to improve patient care.
BACKGROUND: Diagnostic errors made by radiology resident physicians may lead to significant morbidity/mortality and patient dissatisfaction. OBJECTIVE: To determine the etiology and disposition associated with radiology discrepancies on emergency department (ED) patients. METHODS: We conducted a retrospective electronic chart review of patients presenting to our ED during "off hours" at the Penn State Hershey Medical Center during October 2013-November 2014 and had a radiology discrepancy, defined as a patient discharged from the ED with a diagnostic interpretation disagreement between the initial radiology resident physician read and final radiology attending physician read. RESULTS: 81,201 images were performed during "off hours", with 174 radiology discrepancies (0.214%) identified. Most discrepancies were associated with CT scans (62%). The most common final diagnostic interpretations associated with discrepancies were missed fracture (10.9%), incidental findings of mass or cyst (10.3%), gastrointestinal inflammation (6.3%), and pneumonia (5.7%). 10% of radiology discrepancies were instructed to emergently return to the ED. The most common modality associated with ED follow-up was CT scan of the abdomen/pelvis (50%). Of the 17 patients that returned to the ED, 10 had additional diagnostic imaging, 9 received a subspecialist consult, 5 required surgical treatment, 5 required additional medications, and 1 required a medical hospitalization. CONCLUSIONS: Based on our sample, discrepancies were a small percentage of images performed during "off hours", and were associated with CT scans, missed fractures, and non-emergent outpatient follow-up. We suggest that ED and radiology departments work collaboratively to monitor their own rates of discrepancies, and subsequent morbidities and mortalities, to improve patient care.
Authors: Laura Mattijssen-Horstink; Judith Joëlle Langeraar; Gert Jan Mauritz; William van der Stappen; Maarten Baggelaar; Edward Camillus Thwan Han Tan Journal: Scand J Trauma Resusc Emerg Med Date: 2020-05-13 Impact factor: 2.953