Discrepancy rates in after-hours preliminary computed tomography reports at Chris Hani Baragwaneth Academic Hospital: a mixed methods study

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dc.contributor.authorMjoli, Pearl Gugu
dc.contributor.otherQuvane-Mjoli, Pearl
dc.date.accessioned2020-11-29T10:35:24Z
dc.date.available2020-11-29T10:35:24Z
dc.date.issued2019
dc.descriptionA research report submitted in partial fulfilment of the requirements for the degree Masters of Medicine in Diagnostic Radiology to the Faculty of Health Sciences, University of Witwatersrand, Johannesburg, 2019en_ZA
dc.description.librarianTL (2020)en_ZA
dc.description.sponsorshipBackground: Teaching hospitals rely heavily on preliminary radiology reports issued by registrars. In 2012, research identified a 17.1% error rate in preliminary reports at two academic hospitals in Johannesburg, South Africa. Chris Hani Baragwanath Academic Hospital (CHBAH) being the largest academic teaching hospital in South Africa, has a high workload. There is also an increasing and high demand for radiological services. Given that the empirical evidence suggests that diagnostic errors may have an adverse impact on patient outcomes, it was necessary to review the error rates of preliminary after-hours reporting. Purpose: To review the discrepancy rates of preliminary after-hours reporting and to explore the perceived causes thereof. Methods: Secondary analysis was conducted on a cross-section of preliminary radiology reports to identify the error rate, qualify the error type (major vs. minor), and to benchmark against published data in South Africa and internationally. Semi-structured interviews were conducted with registrars at CHBAH and thematically analysed to explore potential causes of errors. Results: 2982 cases were evaluated. The error rate was found to be 18.48%, with a major error rate of 9.96% and a minor error rate of 8.52%. The error rate was comparable to SubSaharan African and international literature of 0.9% to 25 %. The average workload had increased by 94% with registrars reporting an average of 34 scans per shift compared to the previously published 18.5 per shift in the previous study. There was a statistically significant association between body region and error. The “head region” preliminary reports contributed 53.36 % to the error rate followed by followed by “abdomino-pelvic” region (25.95%) preliminary reports. The interviews highlighted the challenges incurred by registrars when reporting as well as possible solutions to change reporting procedures in an attempt to reduce error rates. The key challenges for registrars included workload, shift work, lack of experience, body region scanned, lack of feedback, interruptions from colleagues, uncertainty and fear of disappointing others. Conclusions: This study demonstrates that despite technological advances, there has been no improvement in error rates at CHBAH. The results from this study highlight why certain errors may still be occurring, and by understanding this, registrars (both present and future) and ultimately the patients - will benefit from any action taken towards error reduction. This research puts forward suggested options for guiding policy to influence the further reduction of the discrepancy in the after-hours preliminary reporting at CHBAH, including an intervention to reduce call hours.en_ZA
dc.facultyFaculty of Health Sciencesen_ZA
dc.identifier.urihttps://hdl.handle.net/10539/30250
dc.language.isoenen_ZA
dc.titleDiscrepancy rates in after-hours preliminary computed tomography reports at Chris Hani Baragwaneth Academic Hospital: a mixed methods studyen_ZA
dc.typeThesisen_ZA
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