Identifying errors and inconsistencies in real time while using facilitated echocardiographic reporting

Kirk T Spencer; Bob Arling; Merlijn Sevenster; Jeanne M DeCara; Roberto M Lang; R Parker Ward; Anne M O'Connor; Amit R Patel

doi:10.1016/j.echo.2014.09.005

Identifying errors and inconsistencies in real time while using facilitated echocardiographic reporting

J Am Soc Echocardiogr. 2015 Jan;28(1):88-92.e1. doi: 10.1016/j.echo.2014.09.005. Epub 2014 Oct 16.

Authors

Kirk T Spencer¹, Bob Arling², Merlijn Sevenster³, Jeanne M DeCara⁴, Roberto M Lang⁴, R Parker Ward⁴, Anne M O'Connor⁴, Amit R Patel⁴

Affiliations

¹ University of Chicago, Chicago, Illinois. Electronic address: kspencer@uchicago.edu.
² Philips Healthcare, Andover, Massachusetts.
³ Philips Research North America, Briarcliff Manor, New York.
⁴ University of Chicago, Chicago, Illinois.

PMID: 25441328
DOI: 10.1016/j.echo.2014.09.005

Abstract

Background: Facilitated reporting using a discrete set of finding codes (FCs) is a common method of generating echocardiographic reports.

Methods: The investigators developed a tool that allows echocardiographic reports to be evaluated in real time for errors, omissions, and inconsistencies on the basis of a defined group of "rules" applied to the FCs present in the report. At the time of report finalization, conflicts were displayed for the interpreting physicians, and their responses to each rule conflict were logged.

Results: Over the course of 1 year, 7,986 transthoracic echocardiographic reports were analyzed prospectively during study interpretation. Overall, 30 ± 4.7 FCs were used to generate finalized reports. An average of 2.4 ± 2.0 conflicts were detected per finalized study. Eighty-three percent of studies had at least one conflict identified. There was no significant correlation between physician experience and conflict rates, but time of day (earlier) and rate at which studies were being finalized (faster) were both correlated with increased conflict rate. Overall, physicians ignored identified conflicts 52% of the time and altered their readings to eliminate the conflicts 48% of the time. Overall, at least one change was made in 54% of all finalized studies. There was a small but significant trend for physicians to produce more conflicts over time as the tool was used.

Conclusions: This study demonstrates that facilitated reporting of echocardiographic studies, using a discrete set of FCs, allows the generation of rules that can be used to identify discrepancies in echocardiographic reports before finalization. Conflicts are common in clinical practice, and the identification of these conflicts in real time allowed readers to review their interpretations and frequently resulted in alterations to echocardiographic reports.

Keywords: Echocardiographic interpretation; Error recognition; Facilitated reporting.

MeSH terms

Algorithms
Computer Systems
Decision Support Systems, Clinical / standards*
Diagnostic Errors / classification*
Diagnostic Errors / prevention & control*
Documentation / standards*
Echocardiography / standards*
Pattern Recognition, Automated / standards
Quality Improvement / standards*
United States