Preliminary Radiology Report Discordances and Patient Outcomes

Area of Science:

• Radiology
• Medical Imaging
• Patient Safety

Background:

• Off-hours imaging studies are initially interpreted by resident and fellow radiologists.
• Attending radiologists perform subsequent overreads using structured discrepancy templates.
• This study investigates the clinical impact of major discrepancies found during overreads.

Purpose of the Study:

• To evaluate the effect of major discordance in preliminary radiology reports on patient management and outcomes.
• To identify factors contributing to discrepancies and inform strategies for improvement.

Main Methods:

• Retrospective observational study of preliminary radiology reports from March to June 2017.
• Identification of cases with major discordance via report text search.
• Review of electronic medical records to assess changes in patient management and outcomes.

Main Results:

• Out of 199 discordant cases, 26% led to a change in patient management.
• Only 0.5% of cases had an adverse outcome directly related to the discordant finding.
• Perceptual errors were more common in cases with management changes (73% vs. 59%).
• Improved clinical history could have prevented major report changes in 24% of cases.

Conclusions:

• Adverse outcomes due to discordant imaging findings are infrequent.
• Enhancing clinical history documentation is crucial for reducing major preliminary report changes.
• Strategies to mitigate perceptual errors are essential for improving patient management accuracy.