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CRS54
Out of hours telereporting addendums and discrepancy rates

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TELERADIOLOGY ADDENDUMS ON NON HEAD CT SCANs by Dr Mustafa Sabil & Dr Richard Cooper

 

ž  Background

ž  Aims/Objectives/Standards

ž  Methodology

ž  Results

ž  Conclusions

ž  Recommendations

 

 

Background

 

  • 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.

 

 

Aims/Objectives/Standards

 

  • 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.

 

Standards

 

  • (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

 

 

Methodology

 

  • 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)

 

Results

 

First Audit

 

  Addendums

  • 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

 

Discrepancies:

 

  • 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

 

 

ReAudit

 

  Addendums

  • Sample size – 113
  • Addendum:
  • 87/113 (77%)
  • No Addendum
  • 26/113 (23%)

 

 No Addendums

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%)

 

Discrepancies

 

28/87 – 32%

 

Out of 28 Discrepancies:

  • Minor – 20 (71%)
  • Moderate – 5 (18%)
  • Major – 3 (11%)

 

 

 

Comparison

 

  • 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)

 

Conclusion

 

  • 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.

 

Recommendations

 

  • 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
  • Re-Audit

 

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