Academic radiology and the emergency department: does it need changing?
OBJECTIVE
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.


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.


CONCLUSIONS
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.
Blane
Caroline E
CE
Department of Radiology, The University of Michigan Health System, East Medical Drive, Ann Arbor, MI 48109-0030, USA. cblane@umich.edu
Desmond
Jeffrey S
JS
Helvie
Mark A
MA
Zink
Brian J
BJ
Bailey
Janet E
JE
Yang
Lisa D
LD
Dunnick
N Reed
NR
D002983:Clinical Competence; D003951:Diagnostic Errors; D004636:Emergency Service, Hospital / Q000458:organization & administration*; D006801:Humans; D007396:Internship and Residency; D008511:Medicine; D011446:Prospective Studies; D011872:Radiology Department, Hospital / Q000706:statistics & numerical data*; D013038:Specialization