Radiology double reads.

To cite: Sahni VA, Khorasani R. BMJ Qual Saf 2016;25:569–571. Diagnostic errors in radiology reports can result in patient harm, lead to unnecessary additional testing or interventions, or otherwise diminish the quality of care delivery. 2 In this issue, Lauritzen et al retrospectively evaluated the impact of a quality assurance process using double reads on changes made to abdominal CT reports requested by referring surgeons. The authors address an important topic in this insightful study highlighting the challenges and opportunities related to improving radiology report quality. The authors analysed 1071 consecutive abdominal CT reports on patients referred by surgeons from five public Norwegian hospitals double read by two consultant radiologists over a 17-month period. The request for the second read was initiated at the judgement of the primary radiologist reader who could have been an inexperienced radiologist, an experienced general radiologist, an abdominal radiology subspecialist or a subspecialist in another organ system. Preliminary and final reports were compared for changes and the clinical importance of these changes were rated, on a five-point scale, by at least two gastrointestinal surgeons each with at least 10 years of experience. In addition, the severity of any changes was classified as increased, decreased or unchanged. Of these reports, 146 (14%) were identified as containing clinically important changes; 3 critical, 35 major and 108 intermediate. The severity of the changes was increased in 118 (81%) of reports with clinically important changes. Multivariate analysis demonstrated that important changes were more frequent when the examination was urgent or when the second reader was an abdominal radiologist and less frequent when the first reader was an abdominal radiologist. The primary goal of the radiologist is to provide the referring provider with an actionable imaging report that conveys the pertinent findings identified in an appropriately and correctly performed imaging examination and communicate these findings unambiguously and in a timely manner. Any deviation from this primary objective results in a disservice to our patients and undermines our value as clinicians. The identification of abnormal findings in an imaging examination and their accurate interpretation is the key component of the integrity of an imaging report. Despite our best efforts, diagnostic errors occur at regular frequency within radiology reports. The contributing causes of radiology errors are myriad, but their presence behoves the radiological community to implement quality improvement and quality assurance processes to minimise the presence and impact of errors within imaging reports. A double reading process as described by the authors of this article is one model to diminish diagnostic errors. Such an approach is not conceptually limited to radiology. Presented with the same patient, two surgeons may have differing opinions on treatment options. There are examples of multidisciplinary clinical decision-making processes in cancer care (eg, care for patients with pancreatic cancer typically involves the collaboration of surgeons, medical and radiation oncologists, gastroenterologists, radiologists and pathologists). A major challenge in implementation of such approaches is coordinating and accounting for the needed resources. Lauritzen et al describe an ad hoc prospective double read process initiated by the primary reader presumably due to his/her uncertainty about the presence or clinical relevance of specific imaging findings. By the authors’ own admission, the double read process as described consumes a substantial amount (20%–25%) of their professional resources. It is also interesting that it is the second reader who finalises the report, with a mean delay of approximately 20 h from the preliminary interpretation. In large academic radiology practices in the USA and Canada seeking a consultation from a second reader is EDITORIAL