Klobasa Ingrid, Denham Gary, Roebuck Derek J, Sim Jenny, Baird Marilyn, Petrie Dennis, Best Joshua, Abood James, Tonks Alexandra, Tu Caitlin, Jones Christopher
Department of Medical Imaging and Radiation Sciences, School of Primary and Allied Health Care, Faculty of Medicine, Nursing and Health Sciences, Monash University, Melbourne, Victoria, Australia.
Manning Rural Referral Hospital, Taree, New South Wales, Australia.
Emerg Med Australas. 2025 Feb;37(1):e14503. doi: 10.1111/1742-6723.14503. Epub 2024 Oct 9.
Critical/urgent X-ray findings are not always communicated in an appropriate time frame to ED physicians. The practice of radiographers alerting referrers to clinically significant image findings (verbally, via image flags or written comment) is noted internationally but risk assessment data is unavailable in the literature. A hybrid radiographer comment and alert model was piloted in New South Wales and a risk-benefit assessment conducted for timely and safe communication of abnormal X-ray appearances to ED physicians.
Radiographer comments (n = 1102) were provided to five New South Wales EDs by 69 radiographers for a period of 3-12 months. Site auditors classified comments as true positive (TP), false positive (FP) or indeterminate (ID) with respect to the radiology report. FP comments were investigated with ED referrers and a low-medium-high-risk assessment was provided by two independent reviewers.
A total of 42 FP (3.9%; 95% confidence interval [CI] 2.9-5.3) comments were analysed for any adverse outcomes. Risk assessments demonstrated 37 low, 5 low-moderate and no high-risk cases. A total of 282 direct or potential patient benefits were identified (26.4%; 95% CI 23.8-29.1). A total of 42 radiology report discrepancies were incidentally found: (3.9%; 95% CI 2.9-5.3). Audit results demonstrated areas where the radiographer comment could mitigate risk.
The provision of radiographer alerts with a written comment for ED was found to be low risk to patients in the pilot study. Radiographers communicating directly with the emergency team when abnormal image appearances are detected can reduce diagnostic error and improve patient safety and health outcomes.
危急/紧急的X光检查结果并非总能在适当的时间范围内传达给急诊科医生。放射技师将具有临床意义的影像结果告知转诊医生（通过口头、影像标记或书面评论）的做法在国际上已得到认可，但文献中尚无风险评估数据。在新南威尔士州试行一种放射技师评论与警报混合模式，并对向急诊科医生及时、安全地传达异常X光表现进行风险效益评估。
69名放射技师在3至12个月的时间里向新南威尔士州的5个急诊科提供了放射技师评论（n = 1102条）。现场审核人员根据放射学报告将评论分类为真阳性（TP）、假阳性（FP）或不确定（ID）。对假阳性评论与急诊科转诊医生进行了调查，并由两名独立评审员进行了低-中-高风险评估。
共分析了42条假阳性（3.9%；95%置信区间[CI] 2.9 - 5.3）评论的任何不良后果。风险评估显示有37例低风险、5例低-中度风险，无高风险病例。共确定了282项直接或潜在的患者获益（26.4%；95% CI 23.8 - 29.1）。偶然发现了42项放射学报告差异（3.9%；95% CI 2.9 - 5.3）。审核结果显示了放射技师评论可降低风险的领域。
在试点研究中发现，向急诊科提供带有书面评论的放射技师警报对患者的风险较低。放射技师在检测到异常影像表现时直接与急诊团队沟通，可减少诊断错误，提高患者安全和健康结局。
