Abdominal Imaging Interpretive Errors in a Quality Assurance Database: One Institution's Experience Over a 5-Year...

Area of Science:

• Radiology
• Medical Quality Assurance
• Patient Safety

Background:

• Interpretive errors in diagnostic imaging can lead to patient harm.
• Quality assurance programs aim to identify and mitigate these errors.
• Understanding the relationship between error location and harm is crucial for targeted improvements.

Purpose of the Study:

• To investigate the association between the anatomic location of interpretive errors in abdominal imaging and patient harm.
• To identify specific error locations with higher or lower risks of causing patient harm.

Main Methods:

• A 5-year review of interpretive errors in abdominal and pelvic imaging from a quality assurance database.
• Data collected included imaging exam details, error location, and patient harm assessed using the Agency for Healthcare Research and Quality Harm Scale.
• Multivariable logistic regression was used to analyze the association between anatomic location and harm.

Main Results:

• 263 interpretive errors were identified, with common locations including hepatobiliary, gastrointestinal tract, bone, and reproductive organs.
• 63% of errors resulted in some level of patient harm.
• Error location was significantly associated with patient harm (P=0.003). Kidney/ureter/bladder, gastrointestinal tract, and reproductive organ errors had higher odds of harm compared to hepatobiliary errors.

Conclusions:

• The location of interpretive errors in abdominal radiology is significantly associated with patient harm.
• The most frequently reported error locations are not always the most harmful.
• Findings can guide evidence-based improvements in radiology quality assurance processes.