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In what context are radiologists most likely to make mistakes?

22/04/2019

Radiology reporting errors are a recurring and seemingly inevitable part of radiology practice. Although there is a certain amount of material in the medical literature regarding the cognitive biases and environmental factors that predispose to error, there is little that objectively identifies the reporting context in which reporting errors are most likely to occur.

A recent paper at the British Society of Neuroradiologists has presented one of the first analyses of the context in which recorded radiological reporting errors occur. It was found that the reporting error rate of out-of-hours scans is two-fold greater than that of in-hours reporting, particularly in the context of a consultant checking trainee reports. Although checking of trainee reports constituted only 18% of consultant reporting activity, this category of work made up 52% of erroneous consultant reports.

This study identifies and quantifies a hitherto under-appreciated reporting context that is associated with error. Consultants verifying reports that were first drafted by trainees have a much greater likelihood of making an error compared to reports that were generated solely by a consultant. This is likely to be the result of a ‘double whammy’ framing bias or cognitive heuristic: the bias introduced by a pre-knowledge of the clinical details is compounded by the reading of a pre-existing trainee report, resulting in a much greater likelihood of failing to identify secondary, unexpected abnormalities.

Trainee reporting is the cornerstone of radiology training, but consultants and hospital administrators need to be aware of the great potential for error in this reporting context. It is however frequently the case that insufficient time exists within individual consultant’s job plans to complete considered checking of trainee reports. As such, medical managers need to better support consultants in this task by allotting an appropriate amount of time in their job plans for this role, so that error rates can be minimised.

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