Department of Radiology, Hospital of the University of Pennsylvania, Philadelphia, Pennsylvania 19104, USA.
J Am Coll Radiol. 2011 Sep;8(9):644-8. doi: 10.1016/j.jacr.2011.04.003.
At many academic medical centers, radiology house staff provide preliminary interpretations for imaging studies after hours, the accuracy and timely availability of which are crucial to patient care. Nevertheless, these preliminary interpretations are sometimes discrepant with finalized attending reports. The rate of such discrepancies can provide valuable information for quality improvement. The aim of this study was to identify specific benchmarks for resident discrepancy rates by reviewing all 73,072 on-call reports generated at the authors' institution over 1 year.
A custom-built interface called Orion was used to track all on-call reports generated in 2010. Reports graded as discrepant with major changes during attending review were automatically identified. The turnaround time (TAT) of all reports was measured. These data were used to identify specific benchmarks for resident performance on call.
A total of 45,608 of 73,072 preliminary dictations (62%) were interpreted by residents; of these, 407 (0.89%) had major discrepancies. The major discrepancy rates varied among individual residents (0.2% to 1.8%), modalities, and level of resident training. On the basis of distributions, major discrepancy benchmarks were established for overall rate (1.7%) and for the modalities of conventional radiography (1.5%), CT (4.0%), and ultrasound (4.0%). The mean TAT was significantly shorter for the emergency department (46 minutes) than for inpatient services (144 minutes). A benchmark TAT of 1 hour has been adopted for all imaging studies performed through the emergency department.
Identifying benchmarks for major discrepancy rates and TAT of preliminary interpretations by radiology trainees is a valuable first step for individual and departmental quality improvement.
在许多学术医疗中心，放射科住院医师在非工作时间对影像检查进行初步解读，其准确性和及时性对患者的护理至关重要。然而，这些初步解读有时与主治医生的最终报告不符。这种差异的发生率可以为质量改进提供有价值的信息。本研究的目的是通过回顾作者所在机构一年内生成的所有 73072 份值班报告，确定住院医师差异率的具体基准。
使用名为 Orion 的定制界面来跟踪 2010 年生成的所有值班报告。自动识别在主治医生审查期间有重大改变的报告。测量所有报告的周转时间（TAT）。这些数据用于确定住院医师值班表现的具体基准。
在 73072 份初步听写报告中，共有 45608 份（62%）由住院医师解读；其中，有 407 份（0.89%）存在重大差异。个别住院医师、检查方式和住院医师培训水平的重大差异率各不相同。基于分布情况，为总体发生率（1.7%）和常规放射学（1.5%）、CT（4.0%）和超声（4.0%）的检查方式建立了重大差异基准。急诊（46 分钟）的平均 TAT 明显短于住院服务（144 分钟）。所有通过急诊进行的影像检查都采用了 1 小时的基准 TAT。
确定放射科住院医师主要差异率和初步解读 TAT 的基准是个人和部门质量改进的重要第一步。
