Measuring the impact of resident-attending discrepancies in on-call reporting

Radiology residence training is trending toward a 24-hour coverage model with an accompanying attending practitioner to eliminate resident-attending discrepancies, which are often thought to lead to management changes. A new Academic Radiology study found quantifiable clinical impacts.

The retrospective study, published online Jan. 12, was led by researchers from the Mallinckrodt Institute of Radiology at Washington University in St. Louis. They reviewed mroe than 1,400 discrepancy cases over a 17-month period from a tertiary referral academic radiology residency program.

The authors noted a management change was “subjective with considerable variability in the literature,” but common consistencies included impact to patient management due to admission, discharge, further testing, medical treatment or surgery, wrote Vincent Mellnick, MD, with the Mallinckrodt Institute, and colleagues.

Findings showed of the 1,482 cases, management change occurred 661 times (44.6 percent), with the most common change including follow-up imaging (19 percent) and therapeutic change (14 percent).

“A severity-based discrepancy categorization system successfully identifies those discrepancies with higher clinical impact, allowing management and education efforts to be focused on these cases,” wrote Mellnick et al.

Management changes were more severe with CT examinations, inpatients and discrepancies in the chest and abdomen subspecialty.