1
|
Herpe G, Van den Boom M, Najji R, Tasu JP, Beregi JP, Boyer L, Guillevin R. Associations between 24/7 workforce coverage, organizational challenges, and well-being of emergency radiologists: a national survey. Eur Radiol 2024:10.1007/s00330-024-10945-8. [PMID: 39012527 DOI: 10.1007/s00330-024-10945-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/15/2024] [Revised: 05/02/2024] [Accepted: 06/10/2024] [Indexed: 07/17/2024]
Abstract
BACKGROUND The last decade has seen a surge in the demand for imaging exams in emergency radiology (ER), necessitating an evolution in organizational systems for departments offering round-the-clock care, while safeguarding patient care quality and physician well-being to prevent burnout. PURPOSE To develop a nationwide overview of ER organizations in France and identify structures that promote job satisfaction. MATERIAL AND METHODS Two surveys were sent to 709 radiological centers across France from March to June 2022, inquiring about organizational aspects and quality of life (QOL), incorporating four validated QOL questionnaires. The organization of each center was mapped, and correlations between respondent characteristics and mental health were analyzed using Pearson's and Wilcoxon tests. RESULTS A total of 284 centers answered the organizational survey, with a response rate of about 41.6%. Among them, there were 32 university hospitals, 208 general hospitals, 2 teaching army hospitals, and 42 private facilities. Of these, night-time operations showed 14% on-site coverage, 12% on-call from home, 69% utilized external teleradiology, and 4% used in-house teleradiology. These trends persisted over weekends and holidays. Regarding the quality of working life, academic, general, and private radiologists are more satisfied with their practice compared to trainees. Depersonalization, part of the three dimensions of burnout, was high in every class, at 60% (n = 210/350). CONCLUSION Outside of university hospitals, most radiology centers in France no longer have on-site radiologists during off hours. Residents are prone to lower job satisfaction and quality of life than more experienced radiologists. CLINICAL RELEVANCE STATEMENT The survey illustrates how French ER is structured, pointing out the escalating significance of teleradiology and noting that radiologists generally experience high job satisfaction while also confronting typical organizational challenges. KEY POINTS The need for continuous radiology coverage comes with unique logistical challenges, especially in ER. Night shifts show a significant reliance on teleradiology services, especially by external companies. Pay, shift patterns, and seniority affect the well-being of emergency radiologists, particularly the residents.
Collapse
Affiliation(s)
- Guillaume Herpe
- University Hospital Centre Poitiers, Radiology, Poitiers, Vienne, FR Laboratoire de Mathematiques et Applications Universite de Poitiers, DACTIM MIS TEAM, Chasseneuil, Nouvelle-Aquitaine, France.
| | | | - Rime Najji
- University Hospital Centre Poitiers, Radiology, Poitiers, Vienne, FR Laboratoire de Mathematiques et Applications Universite de Poitiers, DACTIM MIS TEAM, Chasseneuil, Nouvelle-Aquitaine, France
| | | | - Jean-Paul Beregi
- University Hospital Center of Nîmes, Radiology, Nîmes, Gard, France
| | - Louis Boyer
- University Hospital Center of Clermont-Ferrand, Radiology, Clermont-Ferrand, Puy de Dome, France
| | - Rémy Guillevin
- University Hospital Centre Poitiers, Radiology, Poitiers, Vienne, FR Laboratoire de Mathematiques et Applications Universite de Poitiers, DACTIM MIS TEAM, Chasseneuil, Nouvelle-Aquitaine, France
| |
Collapse
|
2
|
Markus DH, Colasanti CA, Kaplan DJ, Manjunath AK, Alaia MJ, Strauss EJ, Jazrawi LM, Campbell KA. High Rate of Patient Satisfaction with Either Telemedicine or Traditional Office-Based Follow-Up Visit After Arthroscopic Shoulder Surgery. Telemed J E Health 2024; 30:134-140. [PMID: 37318834 DOI: 10.1089/tmj.2022.0220] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/17/2023] Open
Abstract
Background: The purpose of this study was to determine if any differences exist in patient satisfaction with office-based visits versus telemedicine visits following arthroscopic shoulder surgery. Methods: Patients undergoing shoulder arthroscopy were prospectively enrolled for 1 year. Patient demographic and clinical data (including complication events) and second postoperative visit satisfaction data were recorded and analyzed for statistical significance. Results: Ninety-six (n = 96) patients met inclusion criteria. Fifty-four patients (56.3%) participated in a traditional in-person office visit, and 42 participated in a video visit (43.8%). No significant differences were found between office and video appointments in terms of overall care satisfaction (9.46 ± 0.9 vs. 9.55 ± 1.0, p = 0.67). Females were significantly less satisfied with their second postoperative visit compared with males (8.3 ± 2.3 vs. 9.3 ± 1.5, p = 0.035). Significantly more females would also have preferred a traditional in person office visit compared with males (91% vs. 67%, p = 0.009). Video appointment patients spent significantly more time with their surgeon than office visit patients (57.64 mean rank vs. 41.39 mean rank, p = 0.003). Discussion: Video visit patients required significantly less time overall for their visit and spent significantly more time with their surgeon, although did not demonstrate differences in satisfaction.
Collapse
Affiliation(s)
- Danielle H Markus
- Division of Sports Medicine, Orthopedic Surgery Department, NYU Langone Health, New York, New York, USA
| | - Christopher A Colasanti
- Division of Sports Medicine, Orthopedic Surgery Department, NYU Langone Health, New York, New York, USA
| | - Daniel J Kaplan
- Division of Sports Medicine, Orthopedic Surgery Department, NYU Langone Health, New York, New York, USA
| | - Amit K Manjunath
- Division of Sports Medicine, Orthopedic Surgery Department, NYU Langone Health, New York, New York, USA
| | - Michael J Alaia
- Division of Sports Medicine, Orthopedic Surgery Department, NYU Langone Health, New York, New York, USA
| | - Eric J Strauss
- Division of Sports Medicine, Orthopedic Surgery Department, NYU Langone Health, New York, New York, USA
| | - Laith M Jazrawi
- Division of Sports Medicine, Orthopedic Surgery Department, NYU Langone Health, New York, New York, USA
| | - Kirk A Campbell
- Division of Sports Medicine, Orthopedic Surgery Department, NYU Langone Health, New York, New York, USA
| |
Collapse
|
3
|
Karimian S, Rahimi B. A systematic review of effects of exchanging and sharing medical images systems in a sociotechnical context: Evaluation perspectives. INFORMATICS IN MEDICINE UNLOCKED 2023. [DOI: 10.1016/j.imu.2023.101212] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 03/15/2023] Open
|
4
|
Yeates EO, Grigorian A, Chinn J, Young H, Colin Escobar J, Glavis-Bloom J, Anavim A, Yaghmai V, Nguyen NT, Nahmias J. Night Radiology Coverage for Trauma: Residents, Teleradiology, or Both? J Am Coll Surg 2022; 235:500-509. [PMID: 35972171 DOI: 10.1097/xcs.0000000000000280] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
BACKGROUND Overnight radiology coverage for trauma patients is often addressed with a combination of on-call radiology residents (RR) and a teleradiology service; however, the accuracy of these 2 readers has not been studied for trauma. We aimed to compare the accuracy of RR versus teleradiologist interpretations of CT scans for trauma patients. STUDY DESIGN A retrospective analysis (March 2019 through May 2020) of trauma patients presenting to a single American College of Surgeons Level I trauma center was performed. Patients whose CT scans were performed between 10 pm to 8 am were included, because their scans were interpreted by both a RR and teleradiologist. Interpretations were compared with the final attending faculty radiologist's interpretation and graded for accuracy based on the RADPEER scoring system. Discrepancies were characterized as traumatic injury or incidental findings and missed findings or overcalls. Turnaround time was also compared. RESULTS A total of 1,053 patients and 8,226 interpretations were included. Compared with teleradiologists, RR had a lower discrepancy (7.7% vs 9.0%, p = 0.026) and major discrepancy rate (3.8% vs 5.2%, p = 0.003). Among major discrepancies, RR had a lower rate of traumatic injury discrepancies (3.2% vs 4.4%, p = 0.004) and missed findings (3.4% vs 5.1%, p < 0.001), but a higher rate of overcalls (0.5% vs 0.1%, p < 0.001) compared with teleradiologists. The mean turnaround time was shorter for RR (51.3 vs 78.8 minutes, p < 0.001). The combination of both RR and teleradiologist interpretations had a lower overall discrepancy rate than RR (5.0% vs 7.7%, p < 0.001). CONCLUSIONS This study identified lower discrepancy rates and a faster turnaround time by RR compared with teleradiologists for trauma CT studies. The combination of both interpreters had an even lower discrepancy rate, suggesting this combination is optimal when an in-house attending radiologist is not available.
Collapse
Affiliation(s)
- Eric O Yeates
- From the Department of Surgery (Yeates, Grigorian, Chinn, Young, Colin Excobar, Nguyen, Nahmias)
| | - Areg Grigorian
- From the Department of Surgery (Yeates, Grigorian, Chinn, Young, Colin Excobar, Nguyen, Nahmias)
- Department of Surgery, University of Southern California (USC), Los Angeles, CA (Grigorian)
| | - Justine Chinn
- From the Department of Surgery (Yeates, Grigorian, Chinn, Young, Colin Excobar, Nguyen, Nahmias)
| | - Hayley Young
- From the Department of Surgery (Yeates, Grigorian, Chinn, Young, Colin Excobar, Nguyen, Nahmias)
| | - Jessica Colin Escobar
- From the Department of Surgery (Yeates, Grigorian, Chinn, Young, Colin Excobar, Nguyen, Nahmias)
| | - Justin Glavis-Bloom
- Department of Radiology (Glavis-Bloom, Anavim, Yaghmai), University of California, Irvine (UCI), Orange, CA
| | - Arash Anavim
- Department of Radiology (Glavis-Bloom, Anavim, Yaghmai), University of California, Irvine (UCI), Orange, CA
| | - Vahid Yaghmai
- Department of Radiology (Glavis-Bloom, Anavim, Yaghmai), University of California, Irvine (UCI), Orange, CA
| | - Ninh T Nguyen
- From the Department of Surgery (Yeates, Grigorian, Chinn, Young, Colin Excobar, Nguyen, Nahmias)
| | - Jeffry Nahmias
- From the Department of Surgery (Yeates, Grigorian, Chinn, Young, Colin Excobar, Nguyen, Nahmias)
| |
Collapse
|
5
|
Vendrell JF, Frandon J, Boussat B, Cotton F, Ferretti G, Sans N, Tasu JP, Beregi JP, Larbi A. Double Reading of Outsourced CT/MR Radiology Reports: Retrospective Analysis. J Patient Saf 2021; 17:e1267-e1271. [PMID: 30531236 DOI: 10.1097/pts.0000000000000525] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
OBJECTIVES Our objective was to determine disagreement rates in radiological reports provided by using a double-reading protocol in a national teleradiology company. METHODS From January 2015 to July 2016, 134169 radiological exams from 36 French centers, benefited outsourced interpretations by certified radiologists, in both regular and after-hours activities. Of these, 2040 CT and MR-scans (1.5%) were subjected to a second opinion by other radiologists in the field of their anatomical specialty (cerebral, thoracic, abdominal-pelvic, and osteoarticular). A five-point agreement scale graded from 0 to 4 was assigned for each exam. Disagreements were considered as minor if no clinical consequence for patient (scores 1 and 2) and major if potential clinical consequence (score 3 and 4). Independent radiologists performed a retrospective analysis and a stratified statistical analysis. RESULTS Double reading was performed on CT-scans (n = 934/2040, 45.8%) and MR-scans (n = 1106/2040, 54.2%) performed in regular (80.1%) and after-hours activities (19.9%). Disagreement scores occurred in 437 exams (21.4%), including major disagreements in 59 (2.9%). Among these, 48/754 were assigned by the thoracic second reader (6.4%), 6/70 by the abdominal-pelvic second reader (8.6%), 3/901 by the osteoarticular second reader (0.3%), and 2/315 by the cerebral second reader (0.6%), with statistical significant difference. No additional disagreement rate was observed in regular and after-hours activities (P = 0.63). CONCLUSIONS Double-reading of outsourced CT and MRI interpretations yielded 21.4% disagreement rate, with potential clinical consequence for patient in 2,9% of the cases. These results are in accordance with those previously reported and suggests that quality assurance of outsourced interpretations is needed.
Collapse
Affiliation(s)
| | - Julien Frandon
- From the department of Radiology, Nîmes University Hospital, Nîmes, France
| | - Bastien Boussat
- Quality of care unit, Grenoble Alpes University Hospital, TIMC UMR 5525 CNRS, Grenoble Alpes University, France
| | - François Cotton
- Department of Radiology, Université de Lyon 1, Hospices Civils de Lyon, Centre Hospitalier Lyon Sud, 69495 Pierre Bénite Cedex, CREATIS INSA - 502, 69621 Villeurbanne Cedex, France
| | - Gilbert Ferretti
- Department of Medical Informatics, Centre Hospitalier et Universitaire de Grenoble, Hôpital Nord, Boulevard de la Chantourne, 38700 La Tronche, France
| | - Nicolas Sans
- Department of Radiology, Centre Hospitalier et Universitaire de Toulouse, Hôpital Pierre-Paul Riquet, Place du Docteur Baylac - TSA 40031, 31059 Toulouse cedex 9
| | - Jean-Pierre Tasu
- Department of radiology, Centre Hospitalier et Universitaire de Poitiers, Hôpital de la Milétrie, 2 Rue de la Milétrie, 86021 Poitiers cedex, France
| | - Jean-Paul Beregi
- From the department of Radiology, Nîmes University Hospital, Nîmes, France
| | - Ahmed Larbi
- From the department of Radiology, Nîmes University Hospital, Nîmes, France
| |
Collapse
|
6
|
Ajrawat P, Young Shin D, Dryan D, Khan M, Ravi B, Veillette C, Leroux T. The Use of Telehealth for Orthopedic Consultations and Assessments: A Systematic Review. Orthopedics 2021; 44:198-206. [PMID: 34292815 DOI: 10.3928/01477447-20210621-08] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/03/2023]
Abstract
As a result of the coronavirus disease 2019 (COVID-19) pandemic, tele-health for orthopedic care is expanding rapidly. The authors sought to identify the evidence describing the effectiveness, barriers, and clinical applications of telehealth for orthopedic assessments and consultations. MEDLINE, PubMed, EMBASE, and the Cochrane Library were searched from inception to March 2020. Forty-seven studies were included, with the most common conditions evaluated being trauma related and the primary modality being videoconferencing. Available literature supports the use of telehealth for orthopedic consultations and assessments because it yields moderate-to-high patient and provider satisfaction, accurate examinations, cost-effectiveness, and reduced wait times. Most commonly reported concerns were professional liability, network security, and technical issues. Given the COVID-19 pandemic, rapid implementation and uptake of virtual assessment for patient care has occurred. The current evidence suggests that telehealth is capable of providing prompt access to quality, cost-efficient orthopedic consultations and assessments. [Orthopedics. 2021;44(4):198--206.].
Collapse
|
7
|
Mancini R, Bartolo M, Pattaro G, Ioni L, Picconi T, Pernazza G. The role of telemedicine in the postoperative home monitoring after robotic colo-rectal cancer surgery: a preliminary single center experience. Updates Surg 2021; 74:171-178. [PMID: 34313956 DOI: 10.1007/s13304-021-01132-1] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/02/2021] [Accepted: 07/07/2021] [Indexed: 10/20/2022]
Abstract
The telemedicine studies, takes care and prevents diseases at distance basing on the interaction among physicians and patients remotely. Few data are available on its application to early postoperative after surgery. The endpoints of our preliminary experience were the detection, as primary, of feasibility and safety of home telemonitoring after robotic colo-rectal resection and, as secondary, perception and satisfaction of the patients. From December 2019 to March 2020, at the Division of Robotic Surgery of San Giovanni Hospital of Rome, 20 of 29 colorectal cancer patients, submitted to Robotic resection, were prospectively included in a program of postoperative home telemonitoring. Telemonitoring was considered feasible if at least 75% of data were available and safe if morbidity ≤ II by Clavien-Dindo classification. Perception and patients' satisfaction were evaluated through a dedicated questionnaire. Out of 20 patients, the median age was 68 years, overall postoperative morbidity was 30%, all events classified Clavien-Dindo Grade I or II. Only 2 patients were corresponded to surgical consult without readmission during home telemonitoring. Compliance of patients was > 80%, overall grade of satisfaction was very high: 4.2 as median (range 0-5). In this preliminary study, the procedures of postoperative home telemonitoring were feasible and safe and high rate of patients' satisfaction was observed. The telemedicine could enhance the role of robotic technique in decrease the hospital stay and improving postoperative recovery after surgery. Further structured prospective trial are needed to validate the routine application of telemedicine in healthcare.
Collapse
Affiliation(s)
- Raffaello Mancini
- Division of Robotic Surgery of San Giovanni Hospital of Rome, Via dell'Amba Aradam, 8, 00184, Rome, Italy.
| | - Michelangelo Bartolo
- Service of Telemedicine of San Giovanni Hospital of Rome, Via dell'Amba Aradam, 8, 00184, Rome, Italy
| | - Giada Pattaro
- Division of Robotic Surgery of San Giovanni Hospital of Rome, Via dell'Amba Aradam, 8, 00184, Rome, Italy
| | - Luigi Ioni
- Division of Robotic Surgery of San Giovanni Hospital of Rome, Via dell'Amba Aradam, 8, 00184, Rome, Italy
| | - Tullio Picconi
- Division of Robotic Surgery of San Giovanni Hospital of Rome, Via dell'Amba Aradam, 8, 00184, Rome, Italy
| | - Graziano Pernazza
- Division of Robotic Surgery of San Giovanni Hospital of Rome, Via dell'Amba Aradam, 8, 00184, Rome, Italy
| | | |
Collapse
|
8
|
The Accuracy of On-Call CT Reporting in Teleradiology Networks in Comparison to In-House Reporting. Healthcare (Basel) 2021; 9:healthcare9040405. [PMID: 33916229 PMCID: PMC8065948 DOI: 10.3390/healthcare9040405] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/04/2021] [Revised: 03/23/2021] [Accepted: 03/26/2021] [Indexed: 11/29/2022] Open
Abstract
(1) Background: We aimed to compare the accuracy of after-hours CT reports created in a traditional in-house setting versus a teleradiology setting by assessing the discrepancy rates between preliminary and final reports. (2) Methods: We conducted a prospective study to determine the number and severity of discrepancies between preliminary and final reports for 7761 consecutive after-hours CT scans collected over a 21-month period. CT exams were performed during on-call hours and were proofread by an attending the next day. Discrepancies between preliminary and gold-standard reports were evaluated by two senior attending radiologists, and differences in rates were assessed for statistical significance. (3) Results: A total of 7209 reports were included in the analysis. Discrepancies occurred in 1215/7209 cases (17%). Among these, 433/7209 reports (6%) showed clinically important differences between the preliminary and final reports. A total of 335/5509 of them were in-house reports (6.1%), and 98/1700 were teleradiology reports (5.8%). The relative frequencies of report changes were not significantly higher in teleradiology. (4) Conclusions: The accuracy of teleradiology reports was not inferior to that of in-house reports, with very similar clinically important differences rates found in both reporting situations.
Collapse
|
9
|
Body MRI Subspecialty Reinterpretations at a Tertiary Care Center: Discrepancy Rates and Error Types. AJR Am J Roentgenol 2020; 215:1384-1388. [PMID: 33052740 DOI: 10.2214/ajr.20.22797] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022]
Abstract
OBJECTIVE. Radiology departments in tertiary care centers are frequently asked to perform secondary interpretations of imaging studies, particularly when a patient is transferred from a community hospital. Discrepancy rates in radiology vary widely, with low rates reported for preliminary resident reports that are overread by attending radiologists (2-6%) and higher rates (up to 56%) for secondary interpretations. Abdominal and pelvic imaging and cross-sectional imaging have the highest discrepancy rates. The purpose of our study was to determine the discrepancy rate and the most common reasons for discrepancies between abdominal and pelvic MRI reports obtained from outside institutions and secondary interpretations of these reports by a fellowship-trained radiologist at a tertiary care center. MATERIALS AND METHODS. We retrospectively identified 395 secondary MRI reports from January 2015 to December 2018 that were labeled as body MRI examinations at a tertiary care center. Thirty-eight cases were excluded for various reasons, including incorrect categorization or lack of outside report. We reviewed the outside reports, compared them with the secondary interpretations, and categorized the cases as discrepancy or no discrepancy. The discrepancies were subdivided into the most likely reason for the error using previously published categories; these categories were also divided into perceptive and cognitive errors. RESULTS. Of the 357 included cases, 246 (68.9%) had at least one discrepancy. The most common reason for error was faulty reasoning (34.3%), which is a cognitive error characterized by misidentifying an abnormality. Satisfaction of search, which is a perceptive error, was the most common reason for second discrepancies (15.0%). CONCLUSION. Secondary interpretations of body MR images at a tertiary care center identify a high rate of discrepancies, with cognitive error types predominating.
Collapse
|
10
|
Cremades M, Ferret G, Parés D, Navinés J, Espin F, Pardo F, Caballero A, Viciano M, Julian JF. Telemedicine to follow patients in a general surgery department. A randomized controlled trial. Am J Surg 2020; 219:882-887. [PMID: 32252983 DOI: 10.1016/j.amjsurg.2020.03.023] [Citation(s) in RCA: 43] [Impact Index Per Article: 10.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/19/2019] [Revised: 03/13/2020] [Accepted: 03/19/2020] [Indexed: 12/14/2022]
Abstract
BACKGROUND Telemedicine is becoming more popular in many medical specialties but few studies have been conducted in General Surgery. This study aims to evaluate the feasibility of its introduction in this specialty. METHODS A prospective randomized clinical trial (RCT) was conducted in 200 patients to compare conventional vs telemedicine follow-up in the outpatient clinics. The primary outcome was the feasibility of telemedicine follow-up and the secondary outcomes were its clinical impact and patient satisfaction. RESULTS Patients were enrolled between March 2017 and April 2018 and there were no statistically significant differences between the groups' characteristics. The primary outcome was achieved in 90% of the conventional follow-up group and in 74% of the telemedicine group (P = 0.003). No differences were found in clinical outcomes (P = 0.832) or patient satisfaction (P = 0.099). CONCLUSION Telemedicine is a good complementary service to facilitate follow-up management in selected patients from a General Surgery department.
Collapse
Affiliation(s)
- Manel Cremades
- General Surgery, Hospital Universitari Germans Trias I Pujol, Spain.
| | - Georgina Ferret
- General Surgery, Hospital Universitari Doctor Josep Trueta, Spain
| | - David Parés
- General Surgery, Hospital Universitari Germans Trias I Pujol, Spain
| | - Jordi Navinés
- General Surgery, Hospital Universitari Germans Trias I Pujol, Spain
| | - Franc Espin
- General Surgery, Hospital Universitari Germans Trias I Pujol, Spain
| | - Fernando Pardo
- General Surgery, Hospital Universitari Germans Trias I Pujol, Spain
| | - Albert Caballero
- General Surgery, Hospital Universitari Germans Trias I Pujol, Spain
| | - Marta Viciano
- General Surgery, Hospital Universitari Germans Trias I Pujol, Spain
| | | |
Collapse
|
11
|
Pilot Study to Evaluate the Safety, Feasibility, and Financial Implications of a Postoperative Telemedicine Program. Ann Surg 2018; 268:700-707. [DOI: 10.1097/sla.0000000000002931] [Citation(s) in RCA: 59] [Impact Index Per Article: 9.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
|
12
|
Telemedicine-based system for quality management and peer review in radiology. Insights Imaging 2018; 9:337-341. [PMID: 29777451 PMCID: PMC5991002 DOI: 10.1007/s13244-018-0629-y] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/08/2017] [Revised: 04/11/2018] [Accepted: 04/16/2018] [Indexed: 11/23/2022] Open
Abstract
Objectives Quality assurance is the key component of modern radiology. A telemedicine-based quality assurance system helps to overcome the “scoring” approach and makes the quality control more accessible and objective. Methods A concept for quality assurance in radiology is developed. Its realization is a set of strategies, actions, and tools. The latter is based on telemedicine-based peer review of 23,199 computed tomography (CT) and magnetic resonance imaging (MRI) images. Results The conception of the system for quality management in radiology represents a chain of actions: “discrepancies evaluation – routine support – quality improvement activity – discrepancies evaluation”. It is realized by an audit methodology, telemedicine, elearning, and other technologies. After a year of systemic telemedicine-based peer reviews, the authors have estimated that clinically significant discrepancies were detected in 6% of all cases, while clinically insignificant ones were found in 19% of cases. Most often, problems appear in musculoskeletal records; 80% of the examinations have diagnostic or technical imperfections. The presence of routine telemedicine support and personalized elearning allowed improving the diagnostics quality. The level of discrepancies has decreased significantly (p < 0.05). Conclusion The telemedicine-based peer review system allows improving radiology departments’ network effectiveness. Main Messages • “Scoring” approach to radiologists’ performance assessment must be changed. • Telemedicine peer review and personalized elearning significantly decrease the number of discrepancies. • Teleradiology allows linking all primary-level hospitals to a common peer review network.
Collapse
|
13
|
Williams AM, Bhatti UF, Alam HB, Nikolian VC. The role of telemedicine in postoperative care. Mhealth 2018; 4:11. [PMID: 29963556 PMCID: PMC5994447 DOI: 10.21037/mhealth.2018.04.03] [Citation(s) in RCA: 82] [Impact Index Per Article: 13.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/16/2018] [Accepted: 04/11/2018] [Indexed: 12/15/2022] Open
Abstract
Telemedicine has become one of the most rapidly-expanding components of the health care system. Its adoption has afforded improved access to care, greater resource efficiency, and decreased costs associated with traditional office visits and has been well established in a wide array of fields. Telemedicine has been adopted in several domains of surgical care. In recent years, the role of telemedicine in postoperative care has caught attention as it has demonstrated excellent clinical outcomes, enhanced patient satisfaction, increased accessibility along with reduced wait times, and cost savings for patients and health care systems. In this narrative review, we describe the history of telemedicine, its adoption in the field of surgery and its various modalities, its use in the postoperative setting, and the potential benefits to both patients and healthcare systems. As telemedicine continues to emerge as a powerful tool for health care delivery, we also discuss several barriers to its widespread adoption as well as the future utility of telemedicine in postoperative care.
Collapse
Affiliation(s)
- Aaron M Williams
- Department of Surgery, University of Michigan, Ann Arbor, MI, USA
| | - Umar F Bhatti
- Department of Surgery, University of Michigan, Ann Arbor, MI, USA
| | - Hasan B Alam
- Department of Surgery, University of Michigan, Ann Arbor, MI, USA
| | | |
Collapse
|
14
|
Pourmand A, Woodward C, Shokoohi H, King JB, Taheri MR, King J, Lawrence C. Impact of Asynchronous Training on Radiology Learning Curve among Emergency Medicine Residents and Clerkship Students. Perm J 2017; 22:17-055. [PMID: 29272248 DOI: 10.7812/tpp/17-055] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/13/2022]
Abstract
CONTEXT Web-based learning (WBL) modules are effectively used to improve medical education curriculum; however, they have not been evaluated to improve head computed tomography (CT) scan interpretation in an emergency medicine (EM) setting. OBJECTIVE To evaluate the effectiveness of a WBL module to aid identification of cranial structures on CT and to improve ability to distinguish between normal and abnormal findings. DESIGN Prospective, before-and-after trial in the Emergency Department of an academic center. Baseline head CT knowledge was assessed via a standardized test containing ten head CT scans, including normal scans and those showing hemorrhagic stroke, trauma, and infection (abscess). All trainees then participated in a WBL intervention. Three weeks later, they were given the same ten CT scans to evaluate in a standardized posttest. MAIN OUTCOME MEASURES Improvement in test scores. RESULTS A total of 131 EM clerkship students and 32 EM residents were enrolled. Pretest scores correlated with stage of training, with students and first-year residents demonstrating the lowest scores. Overall, there was a significant improvement in percentage of correctly classified CT images after the training intervention from a mean pretest score of 32% ± 12% to posttest score of 67% ± 13% (mean improvement = 35% ± 13%, p < 0.001). Among subsets by training level, all subgroups except first-year residents demonstrated a statistically significant increase in scores after the training. CONCLUSION Incorporating asynchronous WBL modules into EM clerkship and residency curriculum provides early radiographic exposure in their clinical training and can enhance diagnostic head CT scan interpretation.
Collapse
Affiliation(s)
- Ali Pourmand
- Associate Professor of Emergency Medicine at George Washington University in Washington, DC.
| | | | - Hamid Shokoohi
- Associate Professor of Emergency Medicine at George Washington University in Washington, DC.
| | - Jordan B King
- Clinical Pharmacy Specialist at Kaiser Permanente in Aurora, CO.
| | - M Reza Taheri
- Associate Professor of Radiology at George Washington University in Washington, DC.
| | - Jackson King
- Medical Student at Washington State University in Spokane.
| | | |
Collapse
|
15
|
Evaluating the Effectiveness, Efficiency and Safety of Telemedicine for Urological Care in the Male Prisoner Population. UROLOGY PRACTICE 2017; 5:44-51. [PMID: 29435485 DOI: 10.1016/j.urpr.2017.01.001] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/08/2023]
Abstract
Introduction We reviewed the safety and effectiveness of our hospital's urologic telemedicine (TM) program that has been utilized for the Iowa prisoner population for over a decade. Methods A retrospective review of TM visits of male prisoners from 2007 to 2014 was performed. Effectiveness of TM visits was assessed by 1) concordance of TM and in-person diagnoses, 2) compliance with radiologic and medication orders and 3) in-person visits saved with TM. Safety was assessed by analyzing the number of patients in which an ED visit was required after TM visit and missed or delayed cases of malignancy. Estimates were then made of the number of patients that could safely be managed with TM alone. Results The most common diagnosis was voiding dysfunction (24%) followed by genitourinary pain (23%). Diagnoses were concordant in 90% of patients; compliance was high (radiology 91%, medications 89%); in-person visits were estimated to be saved in 80-94%. No men required peri-TM ED visits and no cases of malignancy were missed in the population that returned for an in-person visit. We estimated that over 50% of urologic complaints in this cohort could have been managed with TM alone. Conclusions TM was shown to be a safe and effective method to provide general urologic care that obviated the initial in-person visits in nearly 90% of patients. It is likely that TM could safely replace in-person visits for many urologic conditions, especially in younger men and those in which access to specialized care may be limited.
Collapse
|
16
|
Bashshur RL, Krupinski EA, Thrall JH, Bashshur N. The Empirical Foundations of Teleradiology and Related Applications: A Review of the Evidence. Telemed J E Health 2016; 22:868-898. [PMID: 27585301 PMCID: PMC5107673 DOI: 10.1089/tmj.2016.0149] [Citation(s) in RCA: 43] [Impact Index Per Article: 5.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/07/2016] [Accepted: 07/10/2016] [Indexed: 02/06/2023] Open
Abstract
INTRODUCTION Radiology was founded on a technological discovery by Wilhelm Roentgen in 1895. Teleradiology also had its roots in technology dating back to 1947 with the successful transmission of radiographic images through telephone lines. Diagnostic radiology has become the eye of medicine in terms of diagnosing and treating injury and disease. This article documents the empirical foundations of teleradiology. METHODS A selective review of the credible literature during the past decade (2005-2015) was conducted, using robust research design and adequate sample size as criteria for inclusion. FINDINGS The evidence regarding feasibility of teleradiology and related information technology applications has been well documented for several decades. The majority of studies focused on intermediate outcomes, as indicated by comparability between teleradiology and conventional radiology. A consistent trend of concordance between the two modalities was observed in terms of diagnostic accuracy and reliability. Additional benefits include reductions in patient transfer, rehospitalization, and length of stay.
Collapse
Affiliation(s)
| | | | - James H. Thrall
- Department of Radiology, Massachusetts General Hospital, Harvard, Boston, Massachusetts
| | - Noura Bashshur
- University of Michigan Health System, Ann Arbor, Michigan
| |
Collapse
|
17
|
Kara PH, Unluer EE, Eser U, Colak SZ, Kalaycı OT, Demır AO. The focused assessment with computed tomography for trauma: competency of emergency physicians. Am J Emerg Med 2016; 34:1721-3. [PMID: 27321934 DOI: 10.1016/j.ajem.2016.06.032] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/02/2016] [Revised: 06/03/2016] [Accepted: 06/04/2016] [Indexed: 11/24/2022] Open
Affiliation(s)
- Pinar Hanife Kara
- Department of Emergency Medicine, Izmir Katip Celebi University, Ataturk Research and Training Hospital, 35360 Izmir, Turkey.
| | - Erden Erol Unluer
- Department of Emergency Medicine, Izmir Katip Celebi University, Ataturk Research and Training Hospital, 35360 Izmir, Turkey.
| | - Utku Eser
- Department of Family Physician, Izmir Katip Celebi University, Ataturk Research and Training Hospital, 35360 Izmir, Turkey.
| | - Saniye Zengin Colak
- Department of Emergency Medicine, Izmir Katip Celebi University, Ataturk Research and Training Hospital, 35360 Izmir, Turkey.
| | - Ozlem Tugce Kalaycı
- Department of Radiology, Izmir Katip Celebi University, Ataturk Research and Training Hospital, 35360 Izmir, Turkey.
| | - Ali Osman Demır
- Department of Radiology, Izmir Katip Celebi University, Ataturk Research and Training Hospital, 35360 Izmir, Turkey.
| |
Collapse
|
18
|
Lynch KT, Essig RM, Long DM, Wilson A, Con J. Nationwide secondary overtriage in level 3 and level 4 trauma centers: are these transfers necessary? J Surg Res 2016; 204:460-466. [PMID: 27565083 DOI: 10.1016/j.jss.2016.05.035] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/06/2016] [Revised: 04/29/2016] [Accepted: 05/18/2016] [Indexed: 01/28/2023]
Abstract
BACKGROUND Secondary overtriage (SO) refers to the interfacility transfer of trauma patients who are rapidly discharged home without surgical intervention by the receiving institution. SO imposes a financial hardship on patients and strains trauma center resources. Most studies on SO have been conducted from the perspective of the receiving hospital, which is usually a level 1 trauma center. Having previously studied SO from the referring rural hospital's perspective, we sought to identify variables contributing to SO at the national level. METHODS Using data from the 2008-2012 National Trauma Data Bank, we isolated patients transferred to level 1 trauma centers who were: (1) discharged home within 48 h and (2) did not undergo any surgical procedure. This population was subsequently compared with similar patients treated at and discharged directly from level 3 and 4 centers. Multivariate logistic regression analysis was used to isolate variables that independently influenced a patient's risk of undergoing SO. Injury patterns were characterized by use of subspecialty consultants. RESULTS A total of 99,114 patients met inclusion criteria, of which 13.2% were discharged directly from level 3 or 4 trauma centers, and 86.8% of them were transferred to a level 1 trauma center before discharge. The mean Injury Severity Score of the nontransfer and transfer groups was 5.4 ± 4.5 and 7.3 ± 5.7, respectively. Multivariate regression analysis showed that Injury Severity Score > 15, alcoholism, smoking, drug use, and certain injury patterns involving the head, vertebra, and face were associated with being transferred. In this minimally injured population, factors protective against transfers were: age > 65 y, female gender, systolic blood pressure <80, a head computed tomography scan and orthopedic injuries. CONCLUSIONS SO results from the complex interplay of variables including patient demographics, facility characteristics, and injury type. The inability to exclude a potentially devastating neurologic injury seems to drive SO.
Collapse
Affiliation(s)
- Kevin T Lynch
- School of Medicine, West Virginia University, Morgantown, West Virginia
| | - Rachael M Essig
- School of Medicine, West Virginia University, Morgantown, West Virginia
| | - Dustin M Long
- Department of Biostatistics, West Virginia University, Morgantown, West Virginia
| | - Alison Wilson
- Department of Surgery, West Virginia University, Morgantown, West Virginia
| | - Jorge Con
- Department of Surgery, West Virginia University, Morgantown, West Virginia.
| |
Collapse
|
19
|
Gunter RL, Chouinard S, Fernandes-Taylor S, Wiseman JT, Clarkson S, Bennett K, Greenberg CC, Kent KC. Current Use of Telemedicine for Post-Discharge Surgical Care: A Systematic Review. J Am Coll Surg 2016; 222:915-27. [PMID: 27016900 PMCID: PMC5660861 DOI: 10.1016/j.jamcollsurg.2016.01.062] [Citation(s) in RCA: 186] [Impact Index Per Article: 23.3] [Reference Citation Analysis] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/05/2016] [Revised: 01/29/2016] [Accepted: 01/29/2016] [Indexed: 10/22/2022]
Affiliation(s)
- Rebecca L Gunter
- Wisconsin Institute for Surgical Outcomes Research (WiSOR), Madison, WI
| | - Skyler Chouinard
- Wisconsin Institute for Surgical Outcomes Research (WiSOR), Madison, WI
| | | | - Jason T Wiseman
- Wisconsin Institute for Surgical Outcomes Research (WiSOR), Madison, WI
| | - Sam Clarkson
- Wisconsin Institute for Surgical Outcomes Research (WiSOR), Madison, WI
| | - Kyla Bennett
- Wisconsin Institute for Surgical Outcomes Research (WiSOR), Madison, WI
| | | | - K Craig Kent
- Department of Surgery, University of Wisconsin School of Medicine & Public Health, Madison, WI.
| |
Collapse
|
20
|
Second-Opinion Subspecialty Consultations in Musculoskeletal Radiology. AJR Am J Roentgenol 2016; 206:1217-21. [PMID: 27058462 DOI: 10.2214/ajr.15.14540] [Citation(s) in RCA: 52] [Impact Index Per Article: 6.5] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022]
Abstract
OBJECTIVE The purpose of this article is to evaluate the significance of subspecialty second-opinion consultations for CT and MRI examinations in musculoskeletal (MSK) radiology. MATERIALS AND METHODS All 3165 MSK CT and MRI examinations referred to one academic institution for second-opinion consultation during a 24-month period were reviewed by three MSK-trained radiologists. Outside and inside reports were compared by two independent MSK radiology fellows using a previously published 5-point scale. Clinically important differences (categories 4 and 5) were defined as those likely to change patient management. Statistical comparisons of rates were performed using a chi-square test with Bonferroni corrections. Interobserver reliability was reported using linear weighted kappa statistics and the percentage of agreement. RESULTS Of all second-opinion examinations, 73.5% (2326/3165) had an outside report available for comparison and inclusion in this study. There were 610 of 2326 (26.2%) examinations with clinically important differences. The rate of clinically important discrepant readings was even higher in oncologic cases (36.3%; 331/911). When the final diagnosis was determined from pathology reports performed after internal interpretation, the second-opinion consultation was noted to be correct in 82.0% (334/407) of examinations with category 4 or 5 discrepancies. There was very good agreement (κ = 0.93) in scoring the discrepancies between second-opinion consultants. CONCLUSION The subspecialty second-opinion consultation was more accurate than outside reports in 82.0% of examinations when pathologic confirmation was made. A moderate rate (26.2%) of discrepant interpretations was noted between outside and inside MSK imaging examinations, especially in tumor cases (36.3%). Most discrepancies were in interpreting rather than detecting abnormalities.
Collapse
|
21
|
Lindgren EA, Patel MD, Wu Q, Melikian J, Hara AK. The clinical impact of subspecialized radiologist reinterpretation of abdominal imaging studies, with analysis of the types and relative frequency of interpretation discrepancies. ACTA ACUST UNITED AC 2015; 39:1119-26. [PMID: 24748211 DOI: 10.1007/s00261-014-0140-y] [Citation(s) in RCA: 19] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Abstract
PURPOSE The primary objective of this study was to determine the clinical impact and value of abdominal imaging reinterpretations by subspecialized abdominal imagers. METHODS Secondary interpretations for computed tomography (CT), magnetic resonance (MR), and ultrasound (US) abdominal studies performed outside our institution over a 7-month period were retrospectively compared to the primary (outside) interpretation, with interpretive differences recorded. Clinical notes, pathology and subsequent imaging determined ground truth diagnosis and the clinical impact of any interpretive discrepancies were graded as having high, medium, or little/no clinical impact. Interpretive comparisons were scored into categories: (1) no difference; (2) incidental findings of no clinical impact; (3) finding not reported; (4) significance of finding undercalled; (5) significance of finding overcalled; (6) finding misinterpreted; and (7) multiple discrepancy types in one report. RESULTS 398 report comparisons were reviewed on 380 patients. There were 300 CT, 60 MR, and 38 US examinations. The primary report had 5.0% (20/398) high clinical impact interpretive discrepancies and 7.5% (30/398) medium clinical impact discrepancies. The subspecialized secondary report had no high clinical impact discrepancies and 8/398 (2.0%) medium clinical impact discrepancies. In order of frequency, high and medium impact discrepancies in the primary report consisted of 50% overcalls, 26% unreported findings, 18% undercalls, 4% misinterpretations, and 2% multiple discrepancies. CONCLUSIONS Subspecialty review of abdominal imaging exams can provide clinical benefit. Half of the discrepancies in this series of abdominal reinterpretations were due to overcalls.
Collapse
|
22
|
Wu MZ, McInnes MDF, Macdonald DB, Kielar AZ, Duigenan S. CT in adults: systematic review and meta-analysis of interpretation discrepancy rates. Radiology 2013; 270:717-35. [PMID: 24475832 DOI: 10.1148/radiol.13131114] [Citation(s) in RCA: 59] [Impact Index Per Article: 5.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/23/2023]
Abstract
PURPOSE To use meta-analysis to determine the discrepancy rate when interpreting computed tomography (CT) studies performed in adult patients and to determine whether discrepancy rate differs on the basis of body region or level of radiologist training. MATERIALS AND METHODS MEDLINE and EMBASE were searched from 1946 to June 2012 by using the combination "radiology AND (error OR peer review)." Two reviewers independently selected studies that met the inclusion criteria and extracted study data. Total and major discrepancy rates were investigated with a random-effects meta-analysis, and subgroups were compared by using the χ(2) Q statistic. Subgroup analyses were performed on the basis of the level of training of the initial radiologist and the body system scanned. RESULTS Fifty-eight studies met the inclusion criteria (388 123 CT examinations). The pooled total discrepancy rate was 7.7% (95% confidence interval [CI]: 5.6%, 10.3%), and the major discrepancy rate was 2.4% (95% CI: 1.7%, 3.2%). The pooled major discrepancy rate was comparable for staff (2.9%; 95% CI: 1.2%, 6.7%) and residents (2.2%; 95% CI: 1.7%, 2.9%) (Q = 0.92, P = .633). The pooled major discrepancy rates for head CT (0.8%; 95% CI: 0.4%, 1.6%) and spine CT (0.7%; 95% CI: 0.2%, 2.7%) were lower than those for chest CT (2.8%; 95% CI: 1.5%, 5.4%) and abdominal CT (2.6%; 95% CI: 1.0%, 6.7%) (Q = 8.28, P = .041). Lack of blinding of the reference radiologist to the initial report was associated with a lower major discrepancy rate (2.0%; 95% CI: 1.4%, 2.7%; 43 studies) than when blinding was present (12.1%; 95% CI: 4.4%, 29.4%; five studies) (Q = 10.65, P = .001). CONCLUSION Potentially useful reference ranges were identified in the subgroup analyses on the basis of body region scanned at adult CT. However, considerable heterogeneity that is only partially explained by subgroup analysis signifies that further research is necessary--particularly regarding the question of blinding of the reference radiologist.
Collapse
Affiliation(s)
- Mark Z Wu
- From the Department of Medical Imaging, University of Ottawa Faculty of Medicine, Ottawa Hospital Research Institute, 1053 Carling Ave, Room c159, Ottawa, ON, Canada K1Y 4E9 (M.Z.W., M.D.F.M.); and Department of Medical Imaging, the Ottawa Hospital, University of Ottawa, Ottawa, Ont, Canada (D.B.M., A.Z.K., S.D.)
| | | | | | | | | |
Collapse
|
23
|
Hohmann J, de Villiers P, Urigo C, Sarpi D, Newerla C, Brookes J. Quality assessment of out sourced after-hours computed tomography teleradiology reports in a Central London University Hospital. Eur J Radiol 2012; 81:e875-9. [PMID: 22608063 DOI: 10.1016/j.ejrad.2012.04.013] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/31/2011] [Revised: 04/15/2012] [Accepted: 04/19/2012] [Indexed: 10/28/2022]
Abstract
The study was designed to assess the quality of out sourced after-hours computed tomography teleradiology service reports. We evaluated 1028 patients over a time period of five month in 2009/2010 (437 female, 591 male, mean age: 51 years, range: 0-97 years) who were referred either by the A&E or other in house departments from 7 pm to 8 am for different reasons. Reporting was done by a teleradiology service provider located in the UK and Australia. Reports were assessed during the routinely performed morning meeting by a panel of in house radiologists. Assessment was done by a five point agreement scale (5="No disagreement", 1="…unequivocal potential for serious morbidity or threat to life"). In 811 (79%) patients no disagreement was found, 164 (16%) were rated as category 4, 40 (4%) as category 3 ("…likelihood of harm is low"). In 13 (1.3%) patients a decision of category 2 was made ("…strong likelihood of moderate morbidity but not threat to life"). No category 1 decision was made. As this was just a discrepancy decision, a follow up of the category 2 patients was done over a period of a maximum of 6 months. In 8 (0.8%) patients the in house reports were correct, in 2 (0.2%) patients the teleradiology service provider was right and in 3 (0.3%) patients the final diagnoses remained unclear. In conclusion there was a small rate (0.8%) of proven serious misinterpretations by the teleradiology service provider, but these were less than in comparable studies with preliminary in house staff reports (1.6-24.6%).
Collapse
Affiliation(s)
- Joachim Hohmann
- Imaging Department, University College Hospital, University College London Hospitals, University College London, 235 Euston Road, London NW1 2BU, UK.
| | | | | | | | | | | |
Collapse
|
24
|
Abujudeh HH, Boland GW, Kaewlai R, Rabiner P, Halpern EF, Gazelle GS, Thrall JH. Abdominal and pelvic computed tomography (CT) interpretation: discrepancy rates among experienced radiologists. Eur Radiol 2010; 20:1952-7. [PMID: 20336300 DOI: 10.1007/s00330-010-1763-1] [Citation(s) in RCA: 66] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/17/2009] [Revised: 12/07/2009] [Accepted: 01/14/2010] [Indexed: 11/30/2022]
Abstract
OBJECTIVE To assess the discrepancy rate for the interpretation of abdominal and pelvic computed tomography (CT) examinations among experienced radiologists. METHODS Ninety abdominal and pelvic CT examinations reported by three experienced radiologists who specialize in abdominal imaging were randomly selected from the radiological database. The same radiologists, blinded to previous interpretation, were asked to re-interpret 60 examinations: 30 of their previous interpretations and 30 interpreted by others. All reports were assessed for the degree of discrepancy between initial and repeat interpretations according to a three-level scoring system: no discrepancy, minor, or major discrepancy. Inter- and intrareader discrepancy rates and causes were evaluated. RESULTS CT examinations included in the investigation were performed on 90 patients (43 men, mean age 59 years, SD 14, range 19-88) for the following indications: follow-up/evaluation of malignancy (69/90, 77%), pancreatitis (5/90, 6%), urinary tract stone (4/90, 4%) or other (12/90, 13%). Interobserver and intraobserver major discrepancy rates were 26 and 32%, respectively. Major discrepancies were due to missed findings, different opinions regarding interval change of clinically significant findings, and the presence of recommendation. CONCLUSIONS Major discrepancy of between 26 and 32% was observed in the interpretation of abdominal and pelvic CT examinations.
Collapse
Affiliation(s)
- Hani H Abujudeh
- Department of Radiology, Massachusetts General Hospital and Harvard Medical School, Boston, MA, USA.
| | | | | | | | | | | | | |
Collapse
|