After-hours CT report discrepancies: evaluating radiology resident performance

Several prior international studies have examined radiology resident reporting discrepancy rates, with a range of 1-10% quoted. Limited data exists specifically for the after-hours setting, where residents are often staffed at training institutions and report most, or all, studies. Our aims are to determine after-hours resident CT report discrepancy rates at our institution, determine the clinical significance of discrepancies, and assess factors affecting resident performance.

A retrospective review of 2000 after-hours resident CT reports (April through July 2022) was conducted. Preliminary resident reports were compared to attending radiologist finalised reports, with discrepancies categorized into 15 sub-categories; including those that were minor, major and clinically significant. Patient electronic medical records (EMR) were reviewed to assess clinical significance. Statistical analyses were performed using XLStat.

The overall resident CT report discrepancy rate was 44.3% (885/2000), with most discrepancies considered minor changes (67.8%). The rate of major discrepancies was 19.9% (398/2000), while the rate of clinically significant discrepancies was 2.45% (49/2000). The most common major discrepancies included diagnostic misses (16.9%) and overcalls (5.7%). Discrepancies were highest among 2nd-year residents. Significant differences were observed when comparing 2nd- vs. 3rd-year residents (48.1% vs. 39.3%, p < 0.001), early evening vs. overnight shifts (49.5% vs. 38.5%, p < 0.001), and weekdays vs. weekends (49% vs. 38.2%, p < 0.001). No significant differences were found between major or clinically significant discrepancies.

Most resident after-hours CT discrepancies are minor. Our institution demonstrates a low rate of clinically significant discrepancies, which is at the lower end of rates quoted in prior studies. Our findings support high resident performance and reinforce the effectiveness of our current after-hours model in reducing the clinical impact of resident reporting errors.