Radiological services in a hospital emergency department--an evaluation of service delivery and radiograph interpretation.

Radiological services to the Department of Ambulatory Paediatrics were audited over 1 month. Of a total of 782 separate radiographs, more than two-thirds were performed outside hours when radiologists are normally in the hospital. For only 171 of the 782 radiographs (22%) were there immediate reports by a radiologist. To determine whether the absence of immediate radiologist reports affected clinical care, a process was introduced whereby radiologists reviewed interpretation of radiographs made by resident medical officers (RMO) when no report was available. Over a 5 month period 2888 patients had radiographs when there was no immediate radiologist's report. Comparisons were made between RMO interpretation and ultimate radiologist report in 1411 of these patients. In 232 cases (16.4%) there was a discrepancy between RMO interpretation and radiologist report; 70% of these were false positive (the RMO interpreting a normal film as abnormal) while 71 were false negative (the RMO interpreting an abnormal film as normal). This study demonstrates the utility of a relatively simple quality assurance measure in situations where clinical decisions have to be made in the absence of an immediate radiologist report.