Medical cost containment: analysis of dual orthopedic/radiology interpretation of X-rays in the trauma patient.

OBJECTIVE The purpose of this study was to investigate the timing, accuracy, clinical impact, and cost of dual orthopedic and radiology interpretation of orthopedic trauma roentgenograms. DESIGN The investigation was performed in a combined retrospective-prospective fashion. MATERIALS AND METHODS Records of 25 retrospective and 25 prospective trauma patients with femoral fractures were reviewed and the radiology and orthopedic roentgenographic interpretations were compared in terms of four criteria: timing, accuracy, clinical impact, and cost. MEASUREMENTS AND MAIN RESULTS The orthopedic surgeons documented reading 85% of 272 acute roentgenograms in the retrospective patients and 89% of 181 roentgenograms in the prospective patients. The orthopedist readings were immediate, 100% accurate, had significant impact on the patients' care, and incurred no additional cost. The radiologists read 59 and 75% of the retrospective and prospective roentgenograms, respectively. The accuracy rate was 94 and 96%, the time to reading averaged 7 and 4.6 days, and the estimated cost averaged $393 and $200 per patient, respectively. The radiologist readings had no impact on patient care. CONCLUSION This study suggests that routine radiology consultation of musculoskeletal films read by the orthopedic surgeon is not required for the care of the acute trauma patient.