The discrepancy rate between preliminary and official reports of emergency radiology studies: a performance indicator and quality improvement method.
BACKGROUND
At teaching hospitals, radiology residents give preliminary reports for imaging studies requested from the Emergency Department (ED). Discrepancy rates between preliminary and final reports represent an important performance indicator.


OBJECTIVE
To present a system for feedback and follow-up of discrepancies, identify the variables associated with the rate and severity of such discrepancies, target the weaknesses, and suggest the need of a standard reference value for comparison among institutions.


METHODS
A monitoring and communication system between the Department of Diagnostic Radiology and Emergency Department was initiated to mark and follow all studies from the ED for which the official reading was different than the preliminary interpretation. Data analysis was performed on all studies from 1 June 2011 to 31 May 2012, based on the severity of the discrepancy, imaging modality, resident training level, and organ system. The distribution of the number of discrepancies among the different resident levels and imaging modalities was determined, as well as the distribution of three severity scores in correlation with other variables.


RESULTS
The overall discrepancy rate was 1.62%. The discrepancy rate was higher for first and second year residents (1.62% and 1.96%) than for third and fourth year residents (1.35% and 1.24%). It was higher for computed tomography (2.13%) than for radiographs (1.29%) and ultrasound (0.8%) (P value < 0.01), and higher for musculoskeletal (1.61%) than non-musculoskeletal (0.99%) radiographs (P value = 0.0003). Discrepancies with severity score one constituted 35.5% of the total discrepancies, those with severity scores two and three constituted 22.9% and 41.6%, respectively.


CONCLUSIONS
We have demonstrated a system for follow-up of discrepancy in interpreting emergency radiology studies, and recorded the discrepancy rate, with further analysis based on different variables. In terms of quality assurance, a periodical analysis might help to reduce the number of discrepant reports by targeted intervention.
Department of Diagnostic Radiology, American University of Beirut Medical Center, Beirut, Lebanon.
Ghada
G
Issa
Department of Diagnostic Radiology, American University of Beirut Medical Center, Beirut, Lebanon.
Bedros
B
Taslakian
Department of Diagnostic Radiology, American University of Beirut Medical Center, Beirut, Lebanon.
Malak
M
Itani
Department of Emergency Medicine, American University of Beirut Medical Center, Beirut, Lebanon.
Eveline
E
Hitti
Department of Emergency Medicine, American University of Beirut Medical Center, Beirut, Lebanon.
Nicholas
N
Batley
Department of Emergency Medicine, American University of Beirut Medical Center, Beirut, Lebanon.
Miriam
M
Saliba
Department of Diagnostic Radiology, American University of Beirut Medical Center, Beirut, Lebanon fe19@aub.edu.lb.
Fadi
F
El-Merhi
D002983:Clinical Competence / Q000706:statistics & numerical data; D003951:Diagnostic Errors / Q000706:statistics & numerical data*; D003952:Diagnostic Imaging / Q000379:methods / Q000592:standards / Q000706:statistics & numerical data; D004636:Emergency Service, Hospital / Q000706:statistics & numerical data*; D006784:Hospitals, Teaching; D006801:Humans; D007396:Internship and Residency / Q000379:methods / Q000592:standards* / Q000706:statistics & numerical data; D007861:Lebanon; D011446:Prospective Studies; D058996:Quality Improvement / Q000706:statistics & numerical data*; D019984:Quality Indicators, Health Care / Q000706:statistics & numerical data*; D011871:Radiology / Q000379:methods / Q000592:standards* / Q000706:statistics & numerical data
Diagnostic imaging; discrepancy; emergency radiology; misdiagnosis; preliminary report; resident reporting