TELERADIOLOGY ADDENDUMS ON NON HEAD CT SCANs by Dr Mustafa Sabil & Dr Richard Cooper
- Between January 2015 – June 2016 retrospective data was collected for OOH telereporting of non head CT scans done by 4ways.
- Out of hours (8pm to 8am), South Tyneside District Hospital contracts 4ways to provide radiological reports for urgent CT.
- 4ways employs UK radiologists to provide a radiology service for many hospitals across the UK.
- As part of the Trust’s SOP South Tyneside District Hospital’s radiology consultants are expected to provide an addendum to all non-head CT 4ways reports the next working day.
- All non-head CT Scans are to be reviewed by on-site radiologists and an addendum is to be added in all cases.
- RCR reports discrepancy rates to vary between 0-10% with the aim being all CT Scan reports to be less than 5% discrepant.
- (Published reporting discrepancy rates vary between 4% and 30% depending on what is classed as discrepant)
- Standard 1
- A significant discrepancy rate (where patient management is altered) should be less than 5%
- Standard 2
- ALL reports should have an addendum
- Retrospective review of 113 out of hours CT Scans (CT head excluded), previous sample(first audit) size 63.
- All cases from August 2016 onwards.
- All cases are after 8pm on a weekday and 12-30pm on the weekend.
- Addendums added by 4 consultant radiologists in South Tyneside District Hospital since 2015
- Discrepancies classified according to modified DoH (Minor, Moderate & Major)
- Sample Size: 63.
- Out of 63:
- 42 (66%) had an addendum
- 21 (34%) Had no an addendum
- Out of 42 Addendums:
- 26(61%) Agreed
- 16(38%) Discrepant
- Minor – Something trivial, language related or a finding that doesn’t alter management
- Moderate – Finding that materially alters patient management and necessitates a clinician being contacted on a routine basis (e.g. nodule needing a follow up)
- Major – Finding that has immediate consequences for patient (e.g. missed spinal cord compression, missed major haemorrhage, missed unstable fracture or missed cancer).
Out of 16 Discrepancies:
- 13 (81%) – Minor
- 3 (19%) – Moderate
- (0%)– Major
- Sample size – 113
- 87/113 (77%)
- No Addendum
- 26/113 (23%)
- August – 4 (15%)
- September – 7 (27%)
- October – 10 (38%)
- November – 3 (12%)
- December – 0 (0%)
- January – 2 (8%)
Addendums & Discrepancy rates
- 87/113 (77%)
- 59/87 – Agree with report (68%)
- 28/87 – Discrepant (32%)
28/87 – 32%
Out of 28 Discrepancies:
- Minor – 20 (71%)
- Moderate – 5 (18%)
- Major – 3 (11%)
- Although the sample size had almost doubled from 63 to 113 and the number of addendums had increased from 42 to 87, the discrepancy rate had steeply risen from 7% to 29% (all minor discrepancies not included)
- The original audit had no major discrepancies, the reaudit had 3 (11%) (3.44% overall)
- The original audit had 19% moderate discrepancies, the reaudit had 18% (5.7% overall)
- 26 of 113 (23%) had no addendums, standard 1 (100%) not met.
- Of those with addendums 5 were moderate (5.7%) (18%) and 3 were major (3.44%) (11%), overall (9.14%) (29%), standard 2 (<5%) not met.
- Following a reaudit of a larger sample size, the overall outcome was even further from the standard goals.
- Addenda reporting to continue as SOP
- Continue routine reviewing of 4ways non-Head CT scans
- All moderate/major discrepancies to be fed back to 4ways
- Present in LfDM and Trust wide audit
- Discuss with radiology department