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This Week In The Bmj

Lower error rates in reading radiographs can be sustained by redesigning the system

BMJ 2000; 320 doi: (Published 18 March 2000) Cite this as: BMJ 2000;320:b

As part of a quality improvement exercise to reduce the rate of misintepreted radiographs in an emergency department, Espinosa and Nolan discovered that four separate processes for reading radiographs were in operation, involving both emergency physicians and radiologists (p 737). After new training was introduced and all misinterpreted radiographs were routinely reviewed, the error rate fell from 3% to 1.2%. The process of reading radiographs was then simplified, so that emergency physicians read all radiographs, all were reviewed within 12 hours by a radiologist, and patients were called back if any misinterpretations were found. This resulted in a further fall in the error rate to 0.3%, which was sustained over three years. Reliability modelling also confirmed that the redesigned system should result in lower error rates than the original system.