Stephanie Y Jo1, Mary Scanlon2, Tessa Cook3. 1. University of Pennsylvania, Philadelphia, Pennsylvania. Electronic address: stephanie.jo@pennmedicine.upenn.edu. 2. Vice Chair of Education, Chairperson, Radiation Safety Committee, University of Pennsylvania, Philadelphia, Pennsylvania. 3. Assistant Professor of Radiology, Perelman School of Medicine, University of Pennsylvania, Philadelphia, Pennsylvania; Co-Director, Center for Practice Transformation; Fellowship Director, Imaging Informatics, Perelman School of Medicine, University of Pennsylvania, Philadelphia, Pennsylvania.
Abstract
RATIONALE AND OBJECTIVES: At our institution, resident and fellow radiologists issue preliminary reports for off-hours imaging studies, which are overread by attending radiologists the next day using structured discrepancy templates. In this study, we examined the impact on patient management and outcome of studies with major discordance. MATERIALS AND METHODS: For our retrospective observational study, preliminary reports between March and June 2017 that received major discordance were identified through report text search. Electronic medical records were reviewed for patient management change and patient outcome. RESULTS: Of the 199 cases, 52 cases (26%) had management change and 119 cases (60%) did not have management change. In 25 cases (13%), the preliminary report was proven correct on subsequent management. Three cases (2%) were lost to follow-up. In only one case was adverse outcome directly related to the discordant finding. In cases with patient management change, there was higher proportion of perceptual error compared with those without management change (73% versus 59%). In 47 cases (24%), the discordant finding or diagnosis was known to the clinical team, and better history could have avoided the major change. CONCLUSION: Adverse outcome from the discordant imaging finding was low (0.5%). Major change in preliminary report could be reduced with better clinical history. Patient management change was more frequently seen with perceptual errors, placing greater emphasis on strategies to reduce them.
RATIONALE AND OBJECTIVES: At our institution, resident and fellow radiologists issue preliminary reports for off-hours imaging studies, which are overread by attending radiologists the next day using structured discrepancy templates. In this study, we examined the impact on patient management and outcome of studies with major discordance. MATERIALS AND METHODS: For our retrospective observational study, preliminary reports between March and June 2017 that received major discordance were identified through report text search. Electronic medical records were reviewed for patient management change and patient outcome. RESULTS: Of the 199 cases, 52 cases (26%) had management change and 119 cases (60%) did not have management change. In 25 cases (13%), the preliminary report was proven correct on subsequent management. Three cases (2%) were lost to follow-up. In only one case was adverse outcome directly related to the discordant finding. In cases with patient management change, there was higher proportion of perceptual error compared with those without management change (73% versus 59%). In 47 cases (24%), the discordant finding or diagnosis was known to the clinical team, and better history could have avoided the major change. CONCLUSION: Adverse outcome from the discordant imaging finding was low (0.5%). Major change in preliminary report could be reduced with better clinical history. Patient management change was more frequently seen with perceptual errors, placing greater emphasis on strategies to reduce them.