Authors (including presenting author) :
LEUNG KS (1), SZE SENA (2), LIU YT (1), CHAN KY (2), HAU LM (1)
Affiliation :
(1) Quality & Safety Division, NTWC (2) Information Technology and Health Informatics Division, Hospital Authority Head Office
Introduction :
In clinical practice, clinicians may inadvertently overlook unread chest radiographs (CXR), resulting in missing critical pathologies, including lung cancer. Despite the implementation of “Image notification” in Clinical Management System (CMS) since 2022 to remind requesting clinicians to review CXR, a significant number of them remain unread after some time.
Objectives :
To assess the prevalence of unread CXR, identify the reasons behind, and develop strategies to mitigate the risk of overlooked lesions.
Methodology :
The Quality & Safety Division of the New Territories West Cluster (NTWC) collaborated with the Head Office Information Technology and Health Informatics to review all CXR ordered in specialty outpatient clinics from March 2024 to August 2024, except those from Accident & Emergency and Family Medicine Departments. Case lists were generated bi-monthly. All cases were analyzed, particularly whose CXR remained unread for more than three months. We meticulously examined consultation notes in CMS to identify potential reasons for the oversights.
Result & Outcome :
From 1 March 2024 to 31 August 2024, 20,767 CXR were performed in NTWC. Less than 1% of these CXR were unread after three months, but it posed significant risk to delay in clinical management and medicolegal consequences: 49 out of 6,750(0.73%) in March/April; 28 out of 6,924(0.40%) in May/June; and 29 out of 7,093(0.41%) in July/August. Further analysis identified four major factors accounting for these oversights: 1) poor clinical handover due to inadequate documentation (42/106 cases, 39.6%); 2) CXR performed on un-intended date because of ineffective communication among Radiology Department, requesting clinicians, and patients (24/106 cases, 22.6%); 3) requesting clinicians did not review their ordered CXR timely (15/106 cases, 14.2%); 4) Other reasons (25/106 cases, 23.6%). All CXR should be read timely. In response, we implemented targeted strategies to mitigate the risk of oversights. Reminders were sent regularly to clinicians to review their ordered CXR. Bi-monthly reports on unread CXR were sent to their respective department heads to follow. Booking process was enhanced. Training that focused on effective clinical-handover and accurate documentation were on-going. Conclusion: Reviewing CXR timely is crucial. Our initiatives promote a culture of accountability and continuous improvement, ensuring timely attention to critical imaging studies. Effectiveness of these interventions in reducing unread CXR and enhancing communication within clinical teams would be evaluated. This project could be extended to other clusters, to ultimately improve patient care and clinical outcomes for every patient.
