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Preliminary Radiology Resident Interpretations Versus Final Attending Radiologist Interpretations and the Impact on Patient Care in a Community Hospital

¹ Department of Radiology, Monmouth Medical Center, 300 Second Ave., Long Branch, NJ 07740.
² Department of Medical Education, Monmouth Medical Center, Long Branch, NJ 07740.
³ Department of Internal Medicine, Monmouth Medical Center, Long Branch, NJ 07740.

OBJECTIVE. At academic institutions, overnight emergency radiology examinations are interpreted by the on-call radiology resident and are reviewed by an attending radiologist in the morning. The objective of our study was to determine the rate of discrepancies between the two interpretations and the possible effect, if any, on patient care.

MATERIALS AND METHODS. The preliminary reports for 11,908 emergency diagnostic imaging examinations interpreted after hours by residents over a 3-year period (January 2002-January 2005) were reviewed retrospectively for any discrepancy with the attending radiologist's final interpretation. A discrepancy was noted if verbal notification of the ordering physician was required. The medical charts of the cases for which there was a major discrepancy between the two interpretations were reviewed. The discrepancies were categorized as to the effect on patient morbidity. The resident discrepancy rates were also compared with RADPEER data from our institution.

RESULTS. The overall major discrepancy rate was 2.6%. This rate is comparable to RADPEER data, which found a misinterpretation rate of 2.1%. The technique most commonly involved in cases with discrepant interpretations was contrast-enhanced CT of the abdomen and pelvis, with the most common diagnosis related to acute appendicitis (total of 21 cases). The rate of discrepancy was highest for residents who were in their third year of training. The indications for these examinations varied; however, the effect on patient management was no significant effect in 92.8%, some negative effect in 6.9%, and significant negative effect in 0.3%.

CONCLUSION. The results of this investigation highlight the minimal discrepancy rate that occurs with overnight resident coverage. Thus, there is no detrimental effect on the quality of patient care from relying on preliminary interpretations made by radiology residents.

Keywords: academic radiology • diagnostic imaging • emergency radiology • misdiagnosis • on-call radiologist • resident education

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