Free Health Dissertations - The Authors Felt That This Represented An Excellent Approach To What They
The authors felt that this represented an excellent approach to what they described as an error prone activity, reducing mistakes by accident and emergency staff (often junior), increasing patient satisfaction, and reducing long term patient morbidity and litigation. This letter is a significant piece of evidence as it is written by two clinicians who are clearly anxious to assess the system and to make it work. They appreciate the problems, quantify them and address them by placing safeguards to minimise problems. Significantly, they suggest the use of the red dot system - where it has picked up omissions by the clinical staff to be the basis of teaching junior staff in an attempt to further reduce potential problems.
These results should be seen in the context of a study by de Lacey et al.(client to supply date) who considered the accuracy of casualty officer’s interpretation or X-Rays in their departments. They found that by comparing the casualty officer’s interpretation with that of a radiologist, it only compared favourably in 83% of cases. The 17% discrepancy clearly represents a major burden in terms of clinical implications for the patient, financial implications for the hospital and possibly litigation implications for the casualty officer. The study also examines the implications of a delayed reporting system (by the radiologist). It was found to reduce their workload by 25% by restricting their reporting to those films which the casualty officer was unsure or thought may have an abnormality. It clearly follows from this that any measure that is likely to increase efficiency inaccuracy of reporting is likely to have benefits of both economy and patient suffering. We therefore need to examine the premise that the red dot system does exactly that.
These figures are clearly worrying insofar as the 17% discrepancy is a wide margin. The figures still have to be viewed in context however as, although they represent the interpretation of as specialist (the radiologist) as compared with that of the non-specialist (the clinician), the paper does not draw any distinction between the experience levels of the two groups. The clinicians may be comparatively inexperienced casualty officers and the radiologists probably are consultant grade. If that is the case, then the figures are much less alarming. This point is discussed in detail further on in the piece (Williams et al 2000) where radiologists in training are compared to radiologists of consultant grade. The point is brought into sharper focus by consideration of the next two papers.
Before we consider this aspect however, we need to evaluate the accuracy of reporting in the A&E Department environment. Benger and Lyburn (2003) attempted to investigate exactly that. They scrutinised the X-Ray output of an A&E Department over a six month period (nearly 12,000 films).
Dissertations - Free Health Dissertations
