E1659. What Do Residents Miss-On Call? A Large Retrospective Analysis of Preliminary Report Discrepancies
Authors
Shadan Alwan;
University of Texas Health Science Center at Houston
Grace Wang;
University of Texas Health Science Center at Houston
Amir Khadivi;
University of Texas Health Science Center at Houston
Roland Pomfret;
University of Texas Health Science Center at Houston
Eduardo Matta;
University of Texas Health Science Center at Houston
Susanna Spence;
University of Texas Health Science Center at Houston
Mindy Wang;
University of Texas Health Science Center at Houston
Objective:
There are multiple studies that have analyzed the rate of discrepancies between preliminary resident and final attending reports across various settings, including overnight call. Yet, these studies do not report the specific findings missed or overcalled in the resident preliminary reports. Our study’s purpose is to identify and analyze the specific topics of resident interpretation discrepancies by conducting a large retrospective analysis study that has reported and categorized the most common discrepancies in preliminary radiology reports at our institution from July 2017 to June 2020. This may enable targeted educational interventions to identify and reduce the areas of discrepancies in resident reports.
Materials and Methods:
The project was designed as a retrospective analysis study of preliminary resident reports generated from July 2017 to June 2020 at our institution, one of the busiest Level 1 trauma centers in the nation. Our institution’s attending radiologists have provided feedback after overreading preliminary resident’s reports from overnight calls, categorizing discrepancies as “agree,” “minor discrepancy,”or “major discrepancy.” The discrepancy review committee at our institution continually monitor discrepancy data through our PACS (Picture Archiving and Communication System)-based feedback software (Primordial Design, Astoria, New York). The data were then evaluated for discrepant findings and categorized by topics. Exclusion criteria included duplicate reports or no true discrepant findings. To maintain confidentiality, the patient clinical information was stored in a password-protected secure database, with information only containing patient diagnosis as well as medical and treatment history linked to external identification number. The data were only accessible by key study personnel with hospital computers and encrypted devices were used.
Results:
A total of 2935 preliminary reports were collected from July 2017 to June 2020, of which 2529 were included in the study. Each preliminary report had up to one or more discrepancies documented. Based on the specific categories, 796 (32%) report discrepancies were missed fracture injuries, 749 (30%) were missed nonfracture injuries, 861 (34%) were missed acute medical findings, and 192 (8%) were missed tumor findings. A total of 1855 (73%) preliminary reports were categorized as over-read minor discrepancies, and 674 (27%) preliminary reports were categorized as over-read major discrepancies. Data analysis involving further categorization of discrepancies into modality type and subcategories, including type of fracture, type of vascular injury, and specific pathology, is currently pending further analysis.
Conclusion:
The project aims to highlight the categories and topics of discrepancies seen within preliminary resident reports during call. Our data serves to assist in targeted educational efforts on topics that may help decrease discrepancies and improve patient care overall.
