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C Ball, SpR Radiology, Portsmouth Hospitals NHS Trust

National Audit of the Accuracy of Interpretation of Emergency Abdominal CT in Adult Patients Who Present with Non-Traumatic Abdominal Pain. C Ball, SpR Radiology, Portsmouth Hospitals NHS Trust. A Higginson, Consultant Radiologist, Portsmouth Hospitals NHS Trust

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C Ball, SpR Radiology, Portsmouth Hospitals NHS Trust

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  1. National Audit of the Accuracy of Interpretation of Emergency Abdominal CT in Adult Patients Who Present with Non-Traumatic Abdominal Pain C Ball, SpR Radiology, Portsmouth Hospitals NHS Trust

  2. A Higginson, Consultant Radiologist, Portsmouth Hospitals NHS Trust • D Howlett, Consultant Radiologist, East Sussex Hospitals NHS Trust • R Warwick, Chair RCR Clinical Audit Committee • K Drinkwater, RCR Audit Officer

  3. Plan • Background • Aims • Method • Results/coding classification • The future

  4. Background • The NHS is experiencing a period of change with reconfiguration of local services and increasing use of outsourced reporting to external organisations to meet demand and to generate cost savings. • National drive to improve quality with a strong focus on patient safety. • The quality of the report must remain high whether generated by trainee radiologists, consultant trust radiologists or consultant non-trust radiologists.

  5. Aims • To assess major/minor discrepancy rates for provisional and addendum reports • To evaluate the frequency of indeterminate provisional or addendum reporting • To evaluate correlation of provisional +/- addendum report and CT auditor report with laparotomy findings in a surgical group.

  6. Method • Non-Surgical Group – Retrospective identification from 1/1/2013 onwards from the radiology departmental database of 25 consecutive non-traumatic adult (>16 years) emergency patients who had out of hours (6pm – 8am) abdominal/abdominopelvic CT but no laparotomy subsequent to the CT. • Patients who had another intervention during this admission subsequent to the CT (e.g. Colonic/JJ stent, EVAR, percutaneous drainage, laparoscopy) would be included in this category. • CT KUB patients are to be excluded from the audit.

  7. Surgical Group - Retrospective identification from 1/1/2013 onwards using theatre records and the radiology departmental database of 25 consecutive adult patients who underwent a laparotomy as an emergency for an acute abdomen (non-traumatic) and who also underwent emergency abdominal/abdominopelvic CT out of hours as part of their assessment • The laparotomy may have been performed at any time following the CT if deemed relevant to the CT diagnosis

  8. CT Auditor • Onsite trust consultant with experience in reporting abdominal CT. • In cases of major discrepancy there should be case review with another onsite colleague and consensus reached. • CT cases should initially be reviewed in combination with clinical details only.

  9. Results • Auditor questionnaire: Identity whether general/sub-speciality consultant reviewer • Patient questionnaire: Sex/Age/Referral source/Primary reporter/Primary findings/Surgical or Non-surgical group • Surgical group: Time to laparotomy/Surgical findings/CT correlation • Non-surgical group: ? Additional procedure/classify • Concordance – Define impact on patient

  10. Coding • Major Discrepancy – a change or potential change in diagnosis or treatment as a result of addendum/CT auditor review. • Minor Discrepancy – minor differences between provisional/addendum and addendum/auditor reports, unlikely to result in a significant change in patient management. • Indeterminate report – a report where a wide, or non-specific, or inappropriate differential diagnosis is given which leads to indeterminate management advice. These reports will be treated as major discrepancies.

  11. Pilot Results – Provisional Reporter

  12. Pilot Results – Discrepancies

  13. Pilot Results – Disrepancy Impact

  14. The future • Data collection tool currently being finalised by the RCR after feedback from the audit leads • 4 pilot sites have collected data • Audit to go nationwide end of this month – May 2014 • Results distribution at the RCR audit meeting May 2015

  15. References • CT and appendicitis: evaluation of correlation between CT diagnosis and pathological diagnosis; Andre J et al; Postgraduate medical journal; 2008; 84; 321-324 • Discrepancies in interpretation of ED body CT scan reports by radiology residents; N Tieng et al; American journal of emergency medicine; 2007; 25; 45-48 • Evaluating the acute interpretation of emergency medicine resident interpretations of abdominal CTs in patients with non-traumatic abdominal pain; Ju Kang et al; Journal of Korean medical science; 2012; 27; 1255-1266

  16. The DEPICTORS study; Discrepancies in preliminary interpretations of CT scans between on call residents and staff; J Walls et al; Emergency radiology; 2009; 16; 303-308 • Overnight resident preliminary interpretations on CT examinations; Should the process continue? Strub et al; Emergency radiology; 2006; 13; 19-23

  17. Questions please…

  18. Standards

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