Reducing errors made by emergency physicians in interpreting radiographs: longitudinal study

Objectives To reduce errors made in the interpretation of radiographs in an emergency department. Design Longitudinal study. Setting Hospital emergency department. Interventions All staff reviewed all clinically significant discrepancies at monthly meetings. A file of clinically significant errors was created; the file was used for teaching. Later a team redesigned the process. A system was developed for interpreting radiographs that would be followed regardless of the day of the week or time of day. All standard radiographs were brought directly to the emergency physician for immediate interpretation. Radiologists reviewed the films within 12 hours as a quality control measure, and if a significant misinterpretation was found patients were asked to return. Main outcome measures Reduction in number of clinically significant errors (such as missed fractures or foreign bodies) on radiographs read in the emergency department. Data on the error rate for radiologists and the effect of the recall procedure were not available so reliability modelling was used to assess the effect of these on overall safety. Results After the initial improvements the rate of false negative errors fell from 3% (95% confidence interval 2.8% to 3.2%)to 1.2% (1.03% to 1.37%). After the processes were redesigned it fell further to 0.3% (0.26% to 0.34%). Reliability modelling showed that die number of potential adverse effects per 1000 cases fell from 19 before the improvements to-3 afterwards and unmitigated adverse effects fell from 2.2/1000 before to 0.16/1000 afterwards, assuming 95% success in calling patients back. Conclusion Systems of radiograph interpretation that optimise the skills of an clinicians involved and contain reliable processes for mitigating errors can reduce error rates substantially.