After-hours radiology reporting in an Australian tertiary hospital: Factors influencing the rate of discrepancy for computed tomography reporting

Impact of an automated report comparison tool on trainee report modification rate at a tertiary hospital

AIM

This study aims to compare trainee-modified report percentage rate and trainee/consultant satisfaction regarding the feedback process before and after implementation of an automated report comparison tool.

MATERIALS AND METHODS

An automated report comparison tool utilising natural language processing, presenting the trainee's preliminary report beside the final consultant report with changes highlighted, was used in a prospective interventional study. Modification rates, including character counts, of co-authored computed tomography (CT) studies were recorded before and after tool implementation over two 6-month periods and compared with Student's t-test. Trainees and consultants were surveyed before and after the interventional period for time spent and feedback satisfaction.

RESULTS

In total, 3851 (81.7%) of 4175 reports were modified in the baseline preimplementation phase, and 5215 (69.6%) of 7489 reports were modified during the postimplementation phase (p < .001). The average character count change preimplementation was 132, corresponding to 9.0% of the original preliminary report, compared with 91 characters and 7.1% postimplementation, respectively (p < .001). This statistically significant difference generally applied regardless of the level of trainee experience. Prospective data collected in the preimplementation period revealed that for more than two-thirds of after-hours shifts, trainees spent fewer than 5 minutes receiving feedback on their after-hours work. At the conclusion of the implementation phase, 92.3% of trainees and 70% of consultants agreed that the report comparison tool improved feedback.

CONCLUSION

Following the implementation of an automated report comparison tool, there was a reduction in trainee report modification rates and subjectively improved trainee feedback. This adjunct to existing feedback mechanisms presents a relatively simple intervention to facilitate efficient case review and feedback.

Discrepancy rate and clinical impact of preliminary reports from radiology residents

Background

Residents usually cover night and weekend shifts issuing the preliminary reading of radiological studies in university hospitals. This is essential to strengthening decision-making skills when facing complex cases independently. However, there should be a balance between patient safety and academic experience since some concern has been expressed about the accuracy of the interpretations generated by trainees. This work aims to evaluate and characterize the discrepancies in preliminary reports issued by radiology residents.

Material and methods

Radiologists filled out a questionnaire to evaluate preliminary reports of trainees considering diagnosis, findings description, clinical approach changes, and critical findings. Analysis was performed considering modality, imaging type, body part, and resident academic year. A Chi-square test with a significance level α of 0.05 was used to make group comparisons.

Results

A total of 9072 studies were reviewed. Major and minor overall discrepancy rates were 1.7% and 8.3%, respectively. Minor discrepancy rate, findings description, and critical findings identification improved with increasing academic year, both overall and by modality. Discrepancy rates were lower for CT than MR and neuroimaging than for body-imaging studies. The highest major and minor discrepancy rates as abdomen/pelvis CT and lumbar-spine MR, respectively. Two percent of reports presented discrepancies that could generate a medical approach change.

Conclusion

Discrepancy rates are low and comparable with those reported in the literature. These rates tend to improve as the resident's academic year increases. Our results suggest that radiology residents' coverage of night shifts and weekends is a practice that benefits the educational process without negatively impacting patient safety.

Lessons from the contrast dye shortage during COVID-19: A narrative review

The sudden contrast dye shortage, precipitated by a temporary forced closure of healthcare plant, has limited the supply of iodinated contrast media to Australia. Furthering the impact of the coronavirus disease 2019 pandemic, this new crisis has increased burden on the radiology system. Lessons from the strategies applied during the shortage should be used as building blocks as safeguards for the future. A pragmatic approach to education and training is required in an ever-changing environment. Our relationships between medical specialties and manufacturers are paramount to maintaining an effective workflow. An ongoing commitment to a strong workforce will be the backbone to overcome another challenge in these uncertain times.