Routine Use of Structured Reporting in Whole-body Trauma CT Facilitates Quality Improvement

Sophia Freya Ulrike Blum; Diana Hertzschuch; Eric Langer; Felix Schön; Nadine Oppermann; Konrad Kamin; Jens-Peter Kühn; Maria Eberlein-Gonska; Ralf-Thorsten Hoffmann

doi:10.1055/a-2031-2364

RöFo - Fortschritte auf dem Gebiet der Röntgenstrahlen und der bildgebenden Verfahren, Table of Contents

Rofo 2023; 195(06): 521-528
DOI: 10.1055/a-2031-2364

Academic Radiology

Routine Use of Structured Reporting in Whole-body Trauma CT Facilitates Quality Improvement

Beitrag der strukturierten Befundung der Polytrauma-CT zur Qualitätsverbesserung in der Routine

Sophia Freya Ulrike Blum

¹Radiology, University Hospital Carl Gustav Carus at the Technische Universität Dresden, Germany

,

Diana Hertzschuch

²Quality and Medical Risk Management, University Hospital Carl Gustav Carus at the Technische Universität Dresden, Germany

,

Eric Langer

³Institute and Polyclinic for Diagnostic and Interventional Radiology, University Hospital Carl Gustav Carus at the Technische Universität Dresden, Germany

,

Felix Schön

³Institute and Polyclinic for Diagnostic and Interventional Radiology, University Hospital Carl Gustav Carus at the Technische Universität Dresden, Germany

,

Nadine Oppermann

⁴University Center for Orthopaedics and Traumatology, University Hospital Carl Gustav Carus at the Technische Universität Dresden, Germany

,

Konrad Kamin

⁴University Center for Orthopaedics and Traumatology, University Hospital Carl Gustav Carus at the Technische Universität Dresden, Germany

,

Jens-Peter Kühn

³Institute and Polyclinic for Diagnostic and Interventional Radiology, University Hospital Carl Gustav Carus at the Technische Universität Dresden, Germany

,

Maria Eberlein-Gonska

²Quality and Medical Risk Management, University Hospital Carl Gustav Carus at the Technische Universität Dresden, Germany

,

Ralf-Thorsten Hoffmann

³Institute and Polyclinic for Diagnostic and Interventional Radiology, University Hospital Carl Gustav Carus at the Technische Universität Dresden, Germany

› Author Affiliations

Abstract

Purpose Structured reporting (SR) is increasingly used. So far, there is minimal experience with SR in whole-body computed tomography (WBCT). The aim of this study was to investigate the value of routine use of SR in WBCT in trauma with a focus on reporting time, reporting errors, and referrer satisfaction.

Materials and Methods Reporting time and reporting errors of CT reports were prospectively quantified for residents and board-certified radiologists 3 months before and for 6 months after implementation of a structured report in the clinical routine. Referrer satisfaction was prospectively quantified by means of a survey before and after the implementation period of SR using a 5-point Likert scale. Before and after results were compared to determine the effect of structured reporting on WBCT in trauma at our institution.

Results The mean reporting time was lower when using SR (65 ± 52 min. vs. 87 ± 124 min., p = .25). After 4 months, the median reporting time was significantly lower with SR (p = .02). Consequently, the rate of reports that were finished within one hour rose from 55.1 % to 68.3 %. Likewise, reporting errors decreased (12.6 % vs. 8.4 %, p = .48). Residents and board-certified radiologists reported fewer errors when using SR with 16.4 % vs. 12.6 % and 8.8 % vs. 2.7 %, respectively. General referrer satisfaction improved (1.7 ± 0.8 vs. 1.5 ± 1.1, p = .58). Referrers graded improvements for standardization of reports (2.2 ± 1.1 vs. 1.3 ± 1.1, p = .03), consistency of report structure (2.1 ± 1.1 vs. 1.4 ± 1.1, p = .09), and retrievability of relevant pathologies (2.1 ± 1.2 vs. 1.6 ± 1.1, p = .32).

Conclusion SR has the potential to facilitate process improvement for WBCT in trauma in the daily routine with a reduction of reporting time and reporting mistakes while increasing referrer satisfaction.

Key Points:

SR for WBCT in trauma is feasable in clinical routine.
Reporting time in WBCT in trauma decreases by SR.
SR for WBCT in trauma has the potential to decrease reporting mistakes.
SR for WBCT in trauma might increase referrer satisfaction.

Citation Format

Blum SF, Hertzschuch D, Langer E et al. Routine Use of Structured Reporting in Whole-body Trauma CT Facilitates Quality Improvement. Fortschr Röntgenstr 2023; 195: 521 – 528

Zusammenfassung

Ziel Die strukturierte Befundung (SR) findet immer breitere Anwendung in der radiologischen Befundung. Bislang gibt es jedoch kaum Erfahrung in der SR der Computertomografie (CT) beim Polytrauma. Studienziel war die Untersuchung des Beitrages der SR zur Polytrauma-CT hinsichtlich Befundungsdauer, Befundungsfehlern und Zuweiserzufriedenheit.

Material und Methoden Die Befundungsdauer und Befundungsfehler der CT-Primärbefunde wurden prospektiv für Weiterbildungsassistenten und Fachärzte 3 Monate vor (ohne SR) sowie in den ersten 6 Monaten nach Einführung der strukturierten Befundung in der klinischen Routine erfasst. Die Zuweiserzufriedenheit wurde mithilfe einer Befragung vor und nach der Einführung mittels 5-stufiger Likert-Skala erfasst. Die Vorher- und Nachher-Ergebnisse wurden verglichen, um den Effekt der SR bei der Polytrauma-CT an einem universitären Haus zu objektivieren.

Ergebnisse Die mittlere Befundungsdauer war mit der SR kürzer (65 ± 52 min vs. 87 ± 124 min, p = 0,25). Nach 4 Monaten war die mediane Befundungszeit mit der SR signifikant geringer (p = 0,02). In der Folge stieg die Rate an Befundberichten, die innerhalb einer Stunde finalisiert wurden von 55,1 % auf 68,3 %. Gleichzeitig sanken die Befundungsfehler (12,6 % vs. 8,4 %, p = 0,48). Sowohl Weiterbildungsassistenten als auch Fachärzte hatten mit SR weniger Befundungsfehler mit 16,4 % vs. 12,6 % beziehungsweise 8,8 % vs. 2,7 %. Die allgemeine Zuweiserzufriedenheit wurde verbessert (1.7 ± 0.8 vs. 1.5 ± 1.1, p = 0,58). Im Detail bewerteten die Zuweiser deutliche Verbesserungen bei Befundstandardisierung (2.2 ± 1.1 vs. 1.3 ± 1.1, p = 0,03), Konsistenz der Befundstruktur (2.1 ± 1.1 vs. 1.4 ± 1.1, p = 0,09) und Auffindbarkeit relevanter Pathologien (2.1 ± 1.2 vs. 1.6 ± 1.1, p = 0,32).

Schlussfolgerung Die SR hat das Potenzial, eine Prozessverbesserung bei der Polytrauma-CT in der täglichen Routine mit Reduktion der Befundungsdauer und Befundungsfehler bei Verbesserung der Zuweiserzufriedenheit zu ermöglichen.

Kernaussagen:

SR für die Polytrauma-CT ist in der klinischen Routine möglich.
Die Befundungsdauer für die Polytrauma-CT sinkt durch SR.
SR für die Polytrauma-CT hat das Potential Befundungsfehler zu senken.
SR für die Polytrauma-CT könnte die Zuweisezufriedenheit steigern.

Key words

computed tomography - reporting error - quality improvement - trauma - reporting time - structured reporting

Full Text

References

References
1 World Health Organization. Injuries and violence: the facts, 2014. 2014 Im Internet (Stand: 20.02.2022): https://apps.who.int/iris/bitstream/handle/10665/149798/9789241508018_eng.pdf
2 Difino M, Bini R, Reitano E. et al. Epidemiology of trauma admissions in a level 1 trauma center in Northern Italy: a nine-year study. Updat Surg 2021; 73: 1963-1973
3 Candefjord S, Asker L, Caragounis EC. Mortality of trauma patients treated at trauma centers compared to non-trauma centers in Sweden: a retrospective study. Eur J Trauma Emerg Surg 2022; 48: 525-536
4 Fiumedinisi FA, Amsler F, Gross T. Short-term outcome following significant trauma: increasing age per se has only a relatively low impact. Eur J Trauma Emerg Surg 2021; 47: 1979-1992
5 Huber-Wagner S, Lefering R, Qvick LM. et al. Effect of whole-body CT during trauma resuscitation on survival: a retrospective, multicentre study. The Lancet 2009; 373: 1455-1461
6 Wirth S, Hebebrand J, Basilico R. et al. European Society of Emergency Radiology: guideline on radiological polytrauma imaging and service (short version). Insights Imaging 2020; 11: 135
7 The Royal College of Radiologists. Standards of practice and guidance for trauma radiology in severely injured patients, Second edition. 2015 ; Im Internet (Stand: 22.09.2020): https://www.rcr.ac.uk/system/files/publication/field_publication_files/bfcr155_traumaradiol.pdf
8 Deutsche Gesellschaft für Unfallchirurgie e. V. (DGU). S3 – Leitlinie Polytrauma/Schwerverletzten-Behandlung. 2016 ; Im Internet (Stand: 22.09.2020): https://www.awmf.org/leitlinien/detail/ll/012-019.html
9 Deutsche Gesellschaft für Unfallchirurgie e. V. (DGU). Weißbuch Schwerverletztenversorgung. 2019 ; Im Internet (Stand: 21.09.2020): https://www.dgu-online.de/fileadmin/dgu-online/Dokumente/6._Versorgung_und_Wissenschaft/Qualität_und_Sicherheit/2019_DGU-Weissbuch_Schwerverletztenversorgung_3._Auflage_FINAL.PDF
10 Banaste N, Caurier B, Bratan F. et al. Whole-Body CT in Patients with Multiple Traumas: Factors Leading to Missed Injury. Radiology 2018; 289: 374-383
11 Geyer LL, Körner M, Linsenmaier U. et al. Incidence of delayed and missed diagnoses in whole-body multidetector CT in patients with multiple injuries after trauma. 2013; 592-598
12 Yoong S, Kothari R, Brooks A. Assessment of sensitivity of whole-body CT for major trauma. Eur J Trauma Emerg Surg 2019; 45: 489-492
13 Gruen RL, Jurkovich GJ, McIntyre LK. et al. Patterns of Errors Contributing to Trauma Mortality: Lessons Learned From 2594 Deaths. Ann Surg 2006; 244: 371-380
14 Sahni VA, Silveira PC, Sainani NI. et al. Impact of a Structured Report Template on the Quality of MRI Reports for Rectal Cancer Staging. Am J Roentgenol 2015; 205: 584-588
15 Schöppe F. Structured reporting adds value to the evaluation of primary staging CT examinations of patients with diffuse large B-cell lymphoma. 2017; 1001 words.
16 Brown PJ, Rossington H, Taylor J. et al. Standardised reports with a template format are superior to free text reports: the case for rectal cancer reporting in clinical practice. Eur Radiol 2019; 29: 5121-5128
17 Tersteeg JJC, Gobardhan PD, Crolla RMPH. et al. Improving the Quality of MRI Reports of Preoperative Patients With Rectal Cancer: Effect of National Guidelines and Structured Reporting. Am J Roentgenol 2018; 210: 1240-1244
18 Brook OR, Brook A, Vollmer CM. et al. Structured Reporting of Multiphasic CT for Pancreatic Cancer: Potenzial Effect on Staging and Surgical Planning. Radiology 2015; 274: 464-472
19 Ernst BP, Reissig MR, Strieth S. et al. The role of structured reporting and structured operation planning in functional endoscopic sinus surgery. PLOS ONE 2020; 15: e0242804
20 Buckley BW, Daly L, Allen GN. et al. Recall of structured radiology reports is significantly superior to that of unstructured reports. Br J Radiol 2018; 91: 20170670
21 Schwartz LH, Panicek DM, Berk AR. et al. Improving communication of diagnostic radiology findings through structured reporting. Radiology 2011; 260: 174-181
22 Wetterauer C, Winkel DJ, Federer-Gsponer JR. et al. Structured reporting of prostate magnetic resonance imaging has the potential to improve interdisciplinary communication. PLOS ONE 2019; 14: e0212444
23 Lee JK, Bermel R, Bullen J. et al. Structured Reporting in Multiple Sclerosis Reduces Interpretation Time. Acad Radiol 2020; 28: 1733-1738
24 Lin E, Powell DK, Kagetsu NJ. Efficacy of a Checklist-Style Structured Radiology Reporting Template in Reducing Resident Misses on Cervical Spine Computed Tomography Examinations. J Digit Imaging 2014; 27: 588-593
25 Faggioni L, Coppola F, Ferrari R. et al. Usage of structured reporting in radiological practice: results from an Italian online survey. Eur Radiol 2017; 27: 1934-1943
26 Pinto dos Santos D, Hempel JM, Mildenberger P. et al. Structured Reporting in Clinical Routine. Fortschr Röntgenstr 2019; 191: 33-39
27 Ganeshan D, Duong P-AT, Probyn L. et al. Structured Reporting in Radiology. Acad Radiol 2018; 25: 66-73
28 Jorg T, Heckmann JC, Mildenberger P. et al. Structured reporting of CT scans of patients with trauma leads to faster, more detailed diagnoses: An experimental study. Eur J Radiol 2021; 144: 109954
29 Smith CM, Mason S. The use of whole-body CT for trauma patients: survey of UK emergency departments. Emerg Med J 2012; 29: 630-634
30 Dendl LM, Pausch AM, Hoffstetter P. et al. Structured Reporting of Whole-Body Trauma CT Scans Using Checklists: Diagnostic Accuracy of Reporting Radiologists Depending on Their Level of Experience. Fortschr Röntgenstr 2021; 193: 1451-1460
31 European Society of Radiology (ESR). Value-based radiology: what is the ESR doing, and what should we do in the future?. Insights Imaging 2021; 12: 108
32 Abdellatif W, Ding J, Hussien AR. et al. Evaluation of Radiology Reports by the Emergency Department Clinical Providers: A Message to Radiologists. Can Assoc Radiol J 2020; 72: 533-540

Supplementary Material