Strategies for Improving the Value of the Radiology Report: A Retrospective Analysis of Errors in Formally Over-read Studies

• Published in: Journal of the American College of Radiology Vol. 14; no. 4; pp. 459 - 466
• Main Authors: Kabadi, Suraj Jay, MD, Krishnaraj, Arun, MD, MPH
• Format: Journal Article
• Language: English
• Published: United States Elsevier Inc 01.04.2017
• Subjects: actionable impression; clinical data; Electronic Health Records - standards; error; Humans; over-read; Quality Improvement; Radiology; Radiology Department, Hospital - standards; Radiology Information Systems - standards; Retrospective Studies; Structured report; Virginia; Structured report; over-read; error; actionable impression; clinical data
• ISSN: 1546-1440; 1558-349X
• DOI: 10.1016/j.jacr.2016.08.033

Abstract Purpose The radiology report is a critical component of the Imaging Value Chain. Unfortunately, the quality of this aspect of a radiologist’s work is often heterogeneous and fails to add significant value to the referring provider and, ultimately, the patient. Gauging what defines quality can be elusive; however, we elucidate techniques that can be employed to ensure that reports are more comprehensible, actionable, and useful to our customers. Methods Four hundred consecutive studies (July-August 2015) submitted to our institution with request for a formal over-read were reviewed retrospectively, specifically focused on analyzing differences in language, organization, and impression between the outside reports and the formal over-reads performed at our institution. The formal over-reads were classified into one of the following categories: (1) no clinically significant change; (2) emergent clinically significant change; (3) nonemergent clinically significant change. Clinically significant changes were further classified as either perceptual or cognitive errors. Results A total of 12.4% of formally over-read reports had clinically significant changes. Of these, 22.2% were emergent changes. Clinically significant changes were composed of 64.4% perceptual error and 35.6% cognitive error. Four strategies were discovered specifically related to reporting techniques that helped mitigate these errors on formal over-reads: (1) synthesizing varied anatomic findings into a cohesive disease process; (2) integration of relevant electronic health record data; (3) use of structured reporting; and (4) forming actionable impressions. Conclusions We identify, through examples, four strategies for reporting that add value through reduction of radiologic error, helping to mitigate the 12.4% clinically significant error rate found in reinterpretation of outside studies.