Richard B. Ruchman MD, Abstract Co-Author: Nothing to Disclose

Robert Schiff MD, Presenter: Nothing to Disclose

Andrew Charles Schiff BS, Abstract Co-Author: Nothing to Disclose

Kirsten Windos, Abstract Co-Author: Nothing to Disclose

The Emergency Medical Treatment and Active Labor Act outlines the necessity of medical records accompanying individuals transferring to another hospital. No studies to date have methodically analyzed the quality of radiologic reports received by tertiary facilities at the time of patient transfers. The objective of our study is to review the quality of transferred patients’ radiology reports received from three outside institutions. 

All patients transferred from three outside facilities to Monmouth Medical Center from 1/1/2012 to 9/31/2012 were considered. Patients excluded were those with long term acute care or psychiatric admitting diagnoses, inpatient transfers and those without radiologic studies. Three independent observers reviewed the patients’ medical records. Radiologic reports were analyzed according to a modified Likert scale with scores ranging from 1 to 5, representing studies wherein no information was provided versus studies with a complete report, respectively. The data was analyzed with respect to average reader scores, scores according to imaging modality and variance among observers.

Of the initial 447 transfer patients, 111 without imaging were excluded and 53 inpatient transfers were excluded. Of the 283 patients included, the overall modified Likert scale score resulted at 3.43. Per institution, the average scores were 2.92, 3.08 and 4.31. The overall distribution of scores for all institutions across three readers was as follows: 1 - 17.4% (n = 131), 2 - 22.3% (n = 168), 3 - 13.0% (n = 98), 4 - 13.4% (n = 101), 5 - 33.8% (n = 254). Computed tomography (CT) accounted for the majority of studies at 49.6% (n = 140); plain film radiography (XR) was second at 44.7% (n = 126), followed by ultrasonography (US) at 5.7% (n = 16). Within the CT modality, 52.1% (n = 201) of reports were rated as a 5, with 27.1% (n = 108) being rated as a 2 or less; within the XR modality, only 12.4% (n = 40) were rated as a 5, with 54.7% (n = 176) being rated as a 2 or less. By modality, the following variance among observers was seen: US - 0.39, CT - 0.19 and XR - 0.33.

The modified Likert scale score average of 3.43 reveals that most patients arrive with reports entailing only a primary diagnosis and minimal supporting information. Overall, nearly one in three patients in our study arrived with a complete report; more than one third of the patients arrived with an unsupported diagnosis or with no radiology report at all. A more formalized approach to the process of transferring radiologic reports is warranted.

Ruchman, R, Schiff, R, Schiff, A, Windos, K, A Multicenter Analysis of the Quality of Transfer Image Reporting.  Radiological Society of North America 2013 Scientific Assembly and Annual Meeting, December 1 - December 6, 2013 ,Chicago IL. http://archive.rsna.org/2013/13024806.html