Katherine Margaret Krajewski MD, Presenter: Nothing to Disclose

Alexis Potemkin BA, Abstract Co-Author: Nothing to Disclose

Chun-Shan Yam PhD, Abstract Co-Author: Nothing to Disclose

Max Paul Rosen MD, MPH, Abstract Co-Author: Nothing to Disclose

Jacob Sosna MD, Abstract Co-Author: Research grant, Koninklijke Philips Electronics NV

Jonathan B. Kruskal MD, PhD, Abstract Co-Author: Nothing to Disclose

Radiology residents provide preliminary interpretations for many imaging studies that are performed after hours in Emergency Departments (ED). As part of our departmental quality control program, and to address concerns raised by our ED staff, we have audited the nature, frequency and consequences of changes that are made to the initial electronic “wet” read that is written into an ED dashboard.

We developed software to allow us to extract and analyze all changed electronic “wet reads" provided for ED cross-sectional studies performed over 6 months. The authors analyzed the number, nature and impact of changes made to these reads. Changes were categorized as being “life threatening – category 1, “urgent/can be dealt with next day – category 2”, “needs short term follow up – category 3” or “other, including trivial, grammatical etc – category 4”. Changes were correlated with level of resident, study type and time interval between read changes.

A total of 393 changes were made to 9406 ED cross-sectional study wet reads (4.2%) – 95.8% were unchanged. Of the changes 20 (0.05%) were category 1, 59 category 2, 62 category 3 and 252 category 4. 98 cases had 2 changes, 9 cases 3 changes, 3 cases 4 changes and 1 case 5 changes. Abdominal CT scans had most changes (5.4%) followed by chest CTA (5.1%), CT C-spine (2.3%) and CT head (2.1%). 1st residents were responsible for 267 changes (68%), 2nd years 78 (20%), 3rd years 45 (11%) and 4th years 2 (1%). Seven (of 38) residents were responsible for 75.5% of changes. Median + SEM time for changes to category 1, 2 and 3 cases were 47.5 + 13.4, 14.5 + 6.4, and 11.5 + 9.2 minutes respectively.

The majority of “wet reads” provided by residents interpreting ED studies are unchanged. Very few of the changes were considered urgent or life threatening. Certain study types, and less experienced residents are more likely to be associated with changes.

We developed software to monitor ED report changes, and from this data have modified our resident ED teaching curriculum and the content of a pre-call web-based examination.

Krajewski, K, Potemkin, A, Yam, C, Rosen, M, Sosna, J, Kruskal, J, An Audit of Changes Made by Radiology Residents to Electronic "Wet Reads" in an ED Radiology Department.  Radiological Society of North America 2007 Scientific Assembly and Annual Meeting, November 25 - November 30, 2007 ,Chicago IL. http://archive.rsna.org/2007/5004271.html