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Evaluation of an Emergency Radiology Quality Assurance Program at a Level I Trauma Center: Abdominal and Pelvic CT Studies¹

¹ From the Departments of Diagnostic Radiology (L.S.Y., A.H.H., J.A.B., H.P.F.), Trauma Surgery (R.R.), and Economics (H.P.F.), and the School of Management (H.P.F.), Yale University School of Medicine, 333 Cedar St, 2-332 SP, New Haven, CT 06520. From the 2001 RSNA scientific assembly. Received September 5, 2001; revision requested October 10; revision received November 27; accepted January 7, 2002. Address correspondence to H.P.F. (e-mail: howard.forman@yale.edu).

PURPOSE: To evaluate the use of a redundant system in improving quality of care in the trauma setting by examining a subset of our quality assurance program.

MATERIALS AND METHODS: Five hundred thirty-one consecutive abdominal and pelvic CT reports obtained in patients with trauma at a level I trauma center from August 22, 1999, to August 21, 2000, were retrospectively reviewed. Each case was initially interpreted by a board-certified or board-eligible radiologist during evaluation in the emergency department and was subsequently reviewed by a subspecialty abdominal imaging radiologist as part of a quality assurance program. Nineteen cases were excluded because available information was incomplete, resulting in 512 cases in the current study. Cases with discordant interpretations were followed up to discern care change.

RESULTS: Of the 512 trauma cases, 153 (29.9%) showed discordant readings. Review of patient records demonstrated changes in patient care in 12 (7.8%) cases. Three (2.0%) cases were reviewed from the morbidity and mortality records of the Department of Trauma Surgery as a direct result of misinterpretations. Six (4%) cases involved additional diagnostic imaging for reevaluation; in four of these six cases the quality assurance reader’s interpretation was confirmed, while in the other two, the initial interpretations were favored.

CONCLUSION: Findings suggest that discordant radiologic interpretations most often do not result in a change in patient care and outcome. The quality assurance program did, however, identify and lead to changes in care in a number of cases by providing clinically important additional findings.

© RSNA, 2002

Index terms: Abdomen, CT, 70.1211 • Emergency radiology • Pelvis, CT, 80.1211 • Quality assurance

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