Daniel Knight Powell MD, Presenter: Nothing to Disclose

James Eric Silberzweig MD, Abstract Co-Author: Nothing to Disclose

Eaton Lin MD, Abstract Co-Author: Nothing to Disclose

Vladimir Merunka MD, Abstract Co-Author: Nothing to Disclose

Nolan J. Kagetsu MD, Abstract Co-Author: Nothing to Disclose

Evaluate reporting accuracy by residents following recommendation of a checklist structure for maxillofacial CT in an attempt to decrease the rate of undetected pathology.  

We developed a structured checklist macro based on RSNA templates and instituted it in our two residency programs.  We quantified missed pathology 1 year before and 6 months after, recording all faculty addendums and counting important traumatic and incidental pathology (excluding minor findings such as osteomas, tonsillar calcifications, minimal sinus disease, minor arthrosis and limited dental disease).  We surveyed residents and faculty about the impact, including ease of transition and the value of structured reporting.    

There was a statistically significant increase in undetected pathology at program A and no statistically significant change at program B. In the year before the macro, 15.7% of 813 studies at program A had misses (or 6.6% with acute trauma), and over the 6 months after, 27.2% of 404 studies (10.2% acute trauma) had misses (p < 0.01 and 0.05 respectively). At program B, 16.5% of 659 studies had misses (7.4% acute trauma), in the year before, while 20.6% of 189 studies had misses (6.4% acute trauma) over the 5 months after (not statistically significant). Compliance with use of the macro at A (where it originated and was required) was 84.7% compared to 2.7% at B. There were lower miss rates among non-compliant reports than the overall miss rates: 18.5% of 184 at B and 21% of 62 at A. Nine of 18 residents (50%) reported that the macro hindered their search and eleven (61%) reported a difficult transition. Four residents (22%) and 3 faculty (60%) reported that they do not use dictation macros.  

While checklist reporting has a role in standardizing information for clinicians and enhancing safety, it was not successful in improving resident accuracy. It likely will require training and practice to be useful. Compliance appears to be a challenge without consensus and encouragement, as residents outside the program where the macro was designed were essentially non-compliant. The value of checklist reports in guiding seasoned radiologists would be interesting to study.        

Checklist reports were not successful in decreasing missed pathology by residents, compliant with their use. Moreover, the majority of attendings and a quarter of residents do not use macros.  

Powell, D, Silberzweig, J, Lin, E, Merunka, V, Kagetsu, N, Checklists May Be Safe, But They Don’t Teach: Introducing Checklist Structured Reporting to Residents.  Radiological Society of North America 2012 Scientific Assembly and Annual Meeting, November 25 - November 30, 2012 ,Chicago IL. http://archive.rsna.org/2012/12020807.html