From the 2018 HVPAA National Conference
Jeffrey Kempf (Rutgers, Robert Wood Johnson Medical School), Catherine King (Rutgers, Robert Wood Johnson Medical School), Henal Patel (Rutgers, Robert Wood Johnson Medical School), Dhagash Mehta (Rutgers, Robert Wood Johnson Medical School)
Value in diagnostic radiology lies in large part in our ability to answer a clinical question through prompt communication of a written report to the referring physician. At times, however, an addendum to the initial report is performed with potential for minor or major clinical patient impact.
To retrospectively review 8 years of PET/CT scan reports at a tertiary care center, to identify etiologies of report addenda as part of a Radiology Quality Improvement project to identify potential ways to improve patient care.
A total of 6,565 PET/CT studies were performed between Jan 1, 2009 and July 1, 2017. Seven years of data were reviewed of PET studies performed on our PET/CT scanner within our University hospital; with an additional 1.5 years of data collected after it was moved to our on campus outpatient center. An IRB exempt, retrospective analysis was performed utilizing Montage, a data mining software. We searched the keywords “PET/CT” and “addendum.” The reports were reviewed for addenda etiology, time to addenda creation, overall frequency, and assessed through chart review for potential impact on patient care.
Of the 6,565 PET/CT reports obtained, 109 PET report addenda were created with overall frequency of 1.7%. Addenda were categorized by etiology with typographical/proofreading errors being the most common at 21.1%. The 2nd most frequent etiology was to report missed initial findings-20.2%. The 3rd most common reason was to perform comparison with prior studies- 15.6%. Time from initial report completion to generate an addendum was evaluated, with 18.4% created in the first hour; 30.3% of addenda created between 61 min-24 hours; 22.0% of addenda between 24 hours and 7 days; and 18.3% of addenda between 7 days and 1 month. Addenda were categorized as minor, deemed as little to no potential for clinical impact, versus major, deemed as significant potential for adverse clinical impact. Of the 109 addenda, 92.7% of addenda resulted in minor potential clinical impact and 5.5% of reports were felt to have potential for major potential clinical impact. However, chart review revealed no significant adverse patient impact in this series.
There was an overall frequency of PET/CT addenda of 1.7%. The most frequent etiologies included: 1. Typographical/proofreading errors. 2. Missed initial finding. 3. Comparison with prior studies. Overall 5.5% of addenda had potential for major clinical impact. The majority of addenda were created less than 24 hours after initial report completion.
Implications for the Patient
There was a low frequency of PET/CT addenda, 1.7%. 5.5% of reports could have possible major adverse impact; no major adverse results were found on chart review. A revisionist could decrease addenda by 26.6%. 18.4% of addenda could be avoided if reports are not finalized until one hour after completion.