Improved patient outcomes and risk mitigation in Emergency Departments using a hybrid Radiographer Comment model

Abstract

Background/Purpose

Verbal communication of medical imaging findings can be misinterpreted and lacks transparency. A hybrid model using radiographer comments and verbal notification to Emergency Departments (ED) was piloted across five hospitals for the more timely and safe communication of abnormal general x-ray appearances at point of care. Pilot data was evaluated to identify patient benefits and risks.

Methods

A multidisciplinary steering group advised on design and implementation strategies. The radiographer comments were transmitted from imaging consoles to ED dashboards and verbal calls provided to the ED doctor/referring team for critical/urgent conditions.

Radiographer comments (n=1102) were sent to five Emergency Departments (ED) by 69 radiographers (24/7) for a minimum of three months. Positive Predictive Values (PPV), reporting Turn Around Times (TAT) and clinically significant cases were collected at pilot sites. Radiographer comments were compared with radiology reports and classified as True Positive (TP), False Positive (FP) or indeterminate (ID) by two independent auditors. FP and ID comments were investigated with ED referrers and/or site radiologists. Risk assessments were conducted by two independent radiologists using low, moderate, high-very high categories. Radiology report discrepancies found incidentally were confirmed with ED doctors and further imaging data. Wilson Score Intervals determined confidence levels.

Results

The average pooled PPV was 0.96; (0.949 - 0.972; 95% CI). Incorrect comments (42) were analysed for potential harm; (3.9%; 95% CI: 2.9 - 5.3). A risk assessment for these demonstrated 37 low, five moderate and no high-very high-risk cases. 282 patient benefits (26.4 %; 95% CI: 23.8 – 29.1%) and 42 radiology report discrepancies were identified; (3.9%; 95% CI: 2.9 - 5.3).

Conclusions

The model is based on patient advocacy and has the potential to save lives. A quarter of patients benefited from radiographer comments. Risk mitigation was possible in 3.9% of cases. No adverse outcomes were reported.