Quality assessment in an ambulatory care unit: do training and responsibility conflict?

The authors determined the characteristics of musculoskeletal radiographic misinterpretations by 2nd-year internal medicine residents (IMRs) and board-certified emergency department physicians (EDPs) in an ambulatory care unit (ACU) compared with interpretations rendered by staff radiologists. The type (false-positive error [F+] or false-negative error [F-]), site, nature, and clinical significance of errors were assessed. Two hundred thirty-three cases met study requirements; EDPs interpreted 165 cases; IMRs, 68. Discrepancies were found in 55 cases (24%) (44 F- and 11 F+). IMRs committed more F- than did EDPs (25% vs 16%). The most common sites of examination were ankle, finger, and elbow. IMRs missed more periarticular fractures (75%) than did EDPs (33%). The errors were judged "clinically significant" in 7.8% of cases; IMRs made more of these errors than did EDPs (13% vs 4%). Radiologist overview reduced clinically significant errors fivefold. The authors conclude that patient care is well served by clinician-radiologist synergism. The inclusion of selected basic radiologic principles in ACU residency training programs may improve non-radiologists' effective use and interpretation of radiologic examinations.