title: Proctoring of New Emergency Radiologists to Promote Clinical Excellence and Ensure Quality of Care.
abstract: OBJECTIVE
  The authors' institution provides 24/7 attending radiologist final interpretations for all emergency, urgent, and inpatient studies. As a supplement to the existing emergency radiology faculty, the institution relies on two groups of radiologists to provide final imaging interpretations after hours: radiology fellows (RFs) and newly hired subspecialty radiologists (NRs). For both groups, subspecialty services provide overreads the following day to improve the skills of the staff members and ensure clinical excellence. The purpose of this study was to compare the clinical significance and rate of discrepancies between RFs and NRs.
  
  
  METHODS
  A retrospective review of all overreads from July 1, 2012, to June 30, 2015, was performed. Discrepancy rates for RFs and NRs were calculated. Error significance for cases requiring addenda was categorized as follows: acute, likely malignant, indeterminate, unlikely to be of clinical significance, insignificant typographic error, or significant typographic error.
  
  
  RESULTS
  In total, 10,796 studies were rechecked, of which 1.9% (n = 205) required addenda, 3.6% (n = 384) were deemed addendum-optional, and 94.5% (n = 10,207) required no comments. There was no significant difference in cases requiring addenda (RFs, 1.7% [119 of 6,847]; NRs, 2.2% [86 of 3,949]; P = .11). Of the 205 cases requiring addenda, 21.0% (n = 43) were deemed to be acute, 4.9% (n = 10) likely malignant, 28.3% (n = 58) indeterminate, 32.7% (n = 67) unlikely to be of clinical significance, and 13.1% (n = 27) secondary to typographic errors (66.7% [n = 18] deemed to be significant).
  
  
  CONCLUSIONS
  After-hours coverage with RFs and NRs allows high-quality final, actionable interpretations with low discrepancy rates and no significant difference between both groups for addendum-needed cases. The program strikes a balance between the need for timely interpretations and the need to continually monitor and improve the quality of interpretations through subspecialist feedback.
authors.affiliation: Department of Radiology and Biomedical Imaging, Yale School of Medicine, New Haven, Connecticut. Electronic address: m.kelleher@yale.edu.
authors.forename: Michael S
authors.initials: MS
authors.lastname: Kelleher
authors.affiliation: Department of Radiology and Biomedical Imaging, Yale School of Medicine, New Haven, Connecticut.
authors.forename: Howard P
authors.initials: HP
authors.lastname: Forman
authors.affiliation: Department of Radiology and Biomedical Imaging, Yale School of Medicine, New Haven, Connecticut.
authors.forename: T Rob
authors.initials: TR
authors.lastname: Goodman
authors.affiliation: Department of Radiology and Biomedical Imaging, Yale School of Medicine, New Haven, Connecticut.
authors.forename: Jay K
authors.initials: JK
authors.lastname: Pahade
mesh_terms: D039602:After-Hours Care / Q000706:statistics & numerical data; D003237:Connecticut; D003951:Diagnostic Errors / Q000517:prevention & control* / Q000706:statistics & numerical data*; D004636:Emergency Service, Hospital / Q000706:statistics & numerical data; D007396:Internship and Residency / Q000706:statistics & numerical data*; D000071252:Mentoring / Q000706:statistics & numerical data*; D011785:Quality Assurance, Health Care / Q000706:statistics & numerical data*; D058996:Quality Improvement / Q000706:statistics & numerical data; D011787:Quality of Health Care; D000072177:Radiologists / Q000193:education* / Q000706:statistics & numerical data
keywords: Emergency radiology; peer review; quality improvement