title: The costs and effects of introducing selectively trained radiographers to an A&E reporting service: a retrospective controlled before and after study.
abstract: The costs and effects of introducing selectively trained radiographers reporting accident and emergency (A&E) radiographs of the appendicular skeleton in a district general hospital were assessed using a retrospective controlled before and after design. Reference standard reports were compared with a random stratified sample of 200 A&E and 200 general practitioner (GP) reports before and after the intervention. GP reports were used as a non-intervention, non-equivalent control group. An A&E specialist registrar judged whether incorrect A&E reports might have a clinically important effect on patient management. The effect of incorrect A&E reports on outcome was assessed by patient re-attendance to the hospital because of missed abnormalities. The annual, average and incremental costs of radiographers and radiologists reporting A&E radiographs were calculated and a sensitivity analysis was undertaken. The introduction of the radiographers resulted in a 1% (95% CI -7.9 to 5.9) fall in A&E radiograph reporting accuracy and 11% (95% CI -33.7 to 11.3) reduction of cases in which incorrect A&E reports might have a clinically important effect on patient management. Only two A&E reports (one before and one after the intervention) affected patient outcome in that a fracture missed at the first visit resulted in patient re-attendance to the X-ray Department. There was a saving of 361 pounds per annum to the X-ray Department. In conclusion this study provides further evidence that selectively trained radiographers can accurately report A&E plain radiographs and at no additional cost.
authors.affiliation: York Trials Unit, Department of Health Sciences, University of York, York YO10 5DD, UK.
authors.forename: S
authors.initials: S
authors.lastname: Brealey
authors.forename: D G
authors.initials: DG
authors.lastname: King
authors.forename: S
authors.initials: S
authors.lastname: Hahn
authors.forename: C
authors.initials: C
authors.lastname: Godfrey
authors.forename: M T I
authors.initials: MT
authors.lastname: Crowe
authors.forename: K
authors.initials: K
authors.lastname: Bloor
authors.forename: S
authors.initials: S
authors.lastname: Crane
authors.forename: D
authors.initials: D
authors.lastname: Longsworth
mesh_terms: D002983:Clinical Competence; D004496:Education, Continuing; D004636:Emergency Service, Hospital / Q000191:economics / Q000458:organization & administration*; D004739:England; D006302:Health Services Research; D017721:Hospital Costs; D006801:Humans; D017063:Outcome Assessment, Health Care; D011859:Radiography / Q000191:economics*; D011871:Radiology / Q000193:education / Q000458:organization & administration; D011872:Radiology Department, Hospital / Q000191:economics / Q000458:organization & administration*; D012189:Retrospective Studies; D012680:Sensitivity and Specificity