CLINICAL EFFECT OF A QUALITY ASSURANCE SYSTEM FOR RADIOGRAPHS IN A PEDIATRIC EMERGENCY DEPARTMENT

The objective of this study was to determine the clinical relevance an d effectiveness of a quality assurance system used to identify discord ant x-ray interpretations between emergency department pediatricians a nd pediatric radiologists in the emergency department of a large pedia tric hospital, Of 5862 patients who underwent 8174 radiographic studie s during a one year period, 286 patients with discordant radiographic diagnoses were identified, The incidence of discordant radiograph inte rpretation was determined to be 3.5% (286/8174 studies), Of those pati ents with discordant diagnoses, 11.5% (33/286 discordant diagnoses) re ceived immediate intervention by the emergency department, 64.0% (183) received subsequent intervention at their follow-up appointment or by the inpatient team caring for them, 9.4% (27) required no interventio n, and 15.0% (43) had no evidence of necessary intervention documented on their medical record, While only 33/5862 (0.6%) patients receiving radiographs after routine working hours required immediate interventi on by the emergency department, this intervention was potentially life saving, No adverse outcomes were identified in this group of patients who did not receive immediate interpretation of their radiographs by a radiologist, When 24-hour in-house radiology coverage is not provided , a quality assurance system that recalls patients identified with dis cordant radiographic diagnoses, who may require a change in management , appears to be an effective method of patient management only when di scordant interpretations are identified and promptly acted upon.