Report: To reduce diagnostic errors, providers should start with radiology

There are plenty of places in the diagnostic process where things can go wrong. But radiology is a frequent source of medical error that is ripe for reform, according to a new report.

Coverys, a Boston-based medical liability insurer, reviewed more than 10,600 malpractice claims from between 2013 and 2017 and found that nearly 600 named a radiologist explicitly. These cases often related to significant patient harm and delayed diagnosis of serious conditions, according to the group’s report.

About 80% of claims involving radiology were related to misinterpretation of diagnostic reports, according to the study. There is a lot of variability in how different radiologists may read a report, which leaves the door wide open for a mistake, Robert Hanscom, vice president of business analytics at Coverys, said in an interview with FierceHealthcare.

“Radiology has done a lot over the last several years to try and see if they can become a safer discipline,” Hanscom said. “They need to continue to press on a number of fronts—they are still finding themselves very much connected to these poor outcomes.”

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The report identifies several ways that radiology teams can address the risk of medical errors, including:

  • Using clinical decision support
  • Having a clear protocol for bringing in a second opinion on a reading
  • Building templates for reports and using clear language in them
  • Ensuring that incidental findings worthy of follow-up are highlighted so they aren’t missed

Peer review is a key strategy, Hanscom said, especially since the interpretation stage is the riskiest. Getting a second opinion can ensure that nothing on a test result is missed and can prevent communication gaps, such as getting crucial information to the physician that can best use it.

It doesn’t take much for one of these communications breakdowns to occur, Hanscom said. For example, if a patient were to undergo a chest x-ray in the emergency department that shows abnormal spotting, those results may not be taken care of if the only doctors who are made aware are in the ER. If that information doesn’t make it back to the primary care doctor or family doctor, that patient will learn too late that he or she has lung cancer.

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Providers have begun to make strides on some of Coverys’ suggestions, however, Hanscom said. For example, many hospitals are building templates for radiology reports, he said—though the next step to really prevent patient harm would be to standardize those forms nationwide.

More providers are also working toward building clear guidelines on when second opinions are necessary, he said. But addressing the variability of interpretation still requires a lot of work.

“Radiology has to continue to really roll up their sleeves and figure out how they reduce that variation,” Hanscom said.