Neuroimaging reports in a general hospital: Results from a quality-improvement program

• Published in: Clinical neurology and neurosurgery 2010-01, Vol.112 (1), p.54-58
• Main Authors: McCarron, Mark O, Sands, Carrie, McCarron, Peter
• Format: Article
• Language: English
• Subjects: Adult; Aged; Audits; Biological and medical sciences; Brain; Diagnostic Imaging - methods; Female; General hospital; Hospitals; Hospitals, General; Humans; Magnetic Resonance Imaging; Male; Medical imaging; Medical sciences; Middle Aged; MRI; Nervous System Diseases - diagnosis; Nervous System Diseases - therapy; Neuroimaging; Neurology; Neurosurgery; Patient safety; Quality assurance; Quality Assurance, Health Care; Quality-improvement program; Surgery (general aspects). Transplantations, organ and tissue grafts. Graft diseases; Tomography, X-Ray Computed; Treatment Outcome
• ISSN: 0303-8467; 1872-6968
• DOI: 10.1016/j.clineuro.2009.10.009

Abstract Objective Neurologists working in district general hospitals (DGHs) in the UK frequently rely on neuroimaging reports from general radiologists. Neuroradiologists and general radiologists may disagree in the interpretation of magnetic resonance imaging and computerized tomographs of brain and spine. We sought to analyse disagreements between reports from general radiologists and neuroradiologists in selected patients and to examine the impact of a four-point quality-improvement program in a DGH neuroimaging reporting service. Methods A single neurologist selected patients for reporting by neuroradiologists following a recommendation from general radiologists, or because of a concern by the neurologist. Differences between general radiologists and neuroradiologists in pre-planned primary and secondary findings and advice for further investigations were compared. Results Primary finding disagreements occurred in 41 of 307 patients (13.4%) and secondary finding disagreements were identified in 62 patients (20.2%). There was no evidence from either result of improvement compared to an earlier study, p = 0.45 and p = 0.52 respectively. Neuroradiologists suggested further investigations in 42 patients (13.7%). Recurrent areas of disagreement included distinguishing perivascular spaces from ischemia, while recurrent missed lesions included subdural hemorrhage and cortical dysplasia. Conclusions Despite implementation of a quality-improvement program neuroradiologists frequently identified major discrepancies and recommended additional investigations in this DGH neuroimaging service. Future research should identify interventions which are more effective in improving neuroimaging reports in DGHs.