On-Call Radiology Resident Discrepancies: Categorization by Patient Location and Severity.
OBJECTIVE
To report discrepancy rates for examinations interpreted by on-call residents overall and by resident training level, and to describe a novel discrepancy classification system based on patient location and severity that facilitates recording of discrepancy data, helps ensure proper communication of report changes, and allows our radiology department to assume responsibility for contacting discharged patients with non-time-dependent results.


METHODS
A HIPAA-compliant, institutional review board-exempt review of two years (January 2013 to December 2014) of discrepancy data was retrospectively performed for total number of examination interpreted, discrepancy rates, resident training level, and discrepancy categories. Most common diagnoses and means of results communication for discharged patients were also recorded.


RESULTS
Radiology residents interpreted 153,420 examinations after hours and had 2169 discrepancies, for an overall discrepancy rate of 1.4%. Discrepancy rates for postgraduate year (PGY)-3, PGY-4, and PGY-5 residents were 1.31%, 1.65%, and 1.88%, respectively. The rate of critical discrepancies was extremely low (10/153,420 or 0.007%). A total of 502 patients (23.2% of all discrepancies) were discharged at the time their discrepancy was identified, 60% of whom had non-time-dependent discrepancies that were communicated by radiologists; 32.4% of these had addended results telephoned to a PCP, 43.4% had addended results telephoned to the patient, and the remaining 24.2% required a registered letter. Eight percent of patients with non-time-dependent findings were lost to follow-up.


CONCLUSIONS
Our resident discrepancy rates were comparable to those published previously, with extremely low rates of critical discrepancies. Radiologists assumed responsibility for contacting the majority of discharged patients with discrepant results, a minority of whom were lost to follow-up.
Mallinckrodt Institute of Radiology, Washington University School of Medicine, St Louis, Missouri. Electronic address: mellnickv@wustl.edu.
Vincent
V
Mellnick
Mallinckrodt Institute of Radiology, Washington University School of Medicine, St Louis, Missouri.
Constantine
C
Raptis
Mallinckrodt Institute of Radiology, Washington University School of Medicine, St Louis, Missouri.
Sebastian
S
McWilliams
Mallinckrodt Institute of Radiology, Washington University School of Medicine, St Louis, Missouri.
Daniel
D
Picus
Mallinckrodt Institute of Radiology, Washington University School of Medicine, St Louis, Missouri.
Richard
R
Wahl
D039602:After-Hours Care / Q000706:statistics & numerical data*; D002983:Clinical Competence / Q000706:statistics & numerical data*; D003951:Diagnostic Errors / Q000706:statistics & numerical data*; D003952:Diagnostic Imaging / Q000706:statistics & numerical data*; D006801:Humans; D007396:Internship and Residency / Q000706:statistics & numerical data*; D059012:Lost to Follow-Up; D015588:Observer Variation; D010817:Physician-Patient Relations; D011871:Radiology / Q000193:education; D011872:Radiology Department, Hospital / Q000592:standards*; D012189:Retrospective Studies; D012720:Severity of Illness Index; D016526:Workload / Q000706:statistics & numerical data*
Resident; discharged; discrepancies; patient contact; patient location