COMPUTERIZED FOLLOW-UP OF DISCREPANCIES IN IMAGE INTERPRETATION BETWEEN EMERGENCY AND RADIOLOGY DEPARTMENTS

Radiographs are ordered and interpreted for immediate clinical decisio ns 24 hours a day by emergency physicians (EP's). The Joint Commission for Accreditation of Health Care Organizations requires that all thes e images be reviewed by radiologists and that there be some mechanism for quality improvement (QI) for discrepant readings. There must be a log of discrepancies and documentation of follow up activities, but th is alone does not guarantee effective Q.I. Radiologists reviewing imag es from the previous day and night often must guess at the preliminary interpretation of the EP and whether follow up action is necessary. E P's may remain ignorant of the final reading and falsely assume the in itial diagnosis and treatment were correct. Some hospitals use a paper system in which the EP writes a preliminary interpretation on the req uisition slip, which will be available when the radiologist dictates t he final reading. Some hospitals use a classification of discrepancies based on clinical import and urgency, and communicated to the EP on d uty at the time of the official reading, but may not communicate discr epancies to the EP's who initial read the images. Our computerized rad iology department and picture archiving and communications system have increased technologist and radiologist productivity, and decreased re takes and lost films. There are fewer face-to-face consultations of ra diologists and clinicians, but more communication by telephone and ele ctronic annotation of PACS images. We have integrated the QI process f or emergency department (ED) images into the PACS, and gained advantag es over the traditional discrepancy log. Requisitions including clinic al indications are entered into the Hospital Information System and th en appear on the PACS along with images and readings. The initial impr ession, time of review, and the initials of the EP are available to th e radiologist dictating the official report. The radiologist decides i f there is a discrepancy, and whether it is category I (potentially se rious, needs immediate follow-up), category II (moderate risk, follow- up in one day), or category III (low risk, follow-up in several days). During the working day, the radiologist calls immediately for categor y I discrepancies. Those noted from the evening, night, or weekend bef ore are called to the EP the next morning. All discrepancies with the preliminary interpretation are communicated to the EP and are kept in a computerized log for review by a radiologist at a weekly ED teaching conference. This system has reduced the need for the radiologist to a sk or guess what the impression was in the ED the night before. it has reduced the variability in recording of impressions by EP's, in commu nication back from radiologists, in the clinical follow-up made, and i n the documentation of the whole QI process. This system ensures that EP's receive notification of their discrepant readings, and provides c ontinuing education to all the EP's on interpreting images on their pa tients. Copyright (C) 1998 by W.B. Saunders Company.