Increasing Rate of Detection of Wrong-Patient Radiographs: Use of Photographs Obtained at Time of Radiography

Abstract

OBJECTIVE The objective of our study was to evaluate whether facial and chest photographs obtained simultaneously with radiographs increase radiologists’ detection rate of labeling errors. MATERIALS AND METHODS We obtained simultaneous portable radiographs and photographs of 34 patients. We generated 88 pairs of chest radiographs (one recent radiograph, one prior radiograph) and compiled a set of 20 pairs for reader review. Two, three, or four mismatched pairs (i.e., pairs containing radiographs of different patients) were introduced into each list. Ten radiologist readers blinded to the presence of mismatches interpreted the 20 radiograph pairs. Readers then reviewed a second set of 20 pairs containing mismatches but photographs of the patients obtained at the time of imaging were attached to the radiographs. Readers were not instructed regarding the purpose of the photographs. The mismatch detection rate and time for interpretation was recorded for both sessions. The two-tailed Fisher exact test was used to evaluate differences in mismatch detection rates between sessions, with a p value of less than 0.05 being considered significant. RESULTS The error detection rates without (3/24 = 12.5%) and with (16/25 = 64%) photographs significantly differed (p = 0.0003). The average interpretation times without and with photographs were 35.73 and 26.51 minutes, respectively (two-tailed Student t test, p = 0.1165). CONCLUSION The use of photographs increased the detection of errors without a concomitant increase in film interpretation time, which may translate into improvements in patient safety without an increase in interpretation time.

Stakeholders’ Perceptions Regarding the Use of Patient Photographs Integrated with Medical Imaging Studies

“…However, prior observer studies on integrating photographic IDs with imaging had demonstrated minimal potential impact on interpretation times [7,8,16]. Additionally, 33 % of radiologists in the current study believed that photographic IDs might be distracting.…”

“…Including patients' photos in EMR in an order verification screen prior to final signing of orders is an effective strategy for reducing the risk that medication orders will be placed in an unintended patient's EMR [14]. In radiology, observer studies demonstrated that facial photographs obtained at the time of portable chest radiographs increase detection rate of wrong-patient errors [7,8]. Other small studies (sample size of less than 50) assessing the impact of having patients' photographs available at the time of radiologists' interpretation of imaging showed no significant difference in the presence and number of clinically significant findings, when compared to studies without attached patient's photographs [15].…”

“…Additionally, 33 % of radiologists in the current study believed that photographic IDs might be distracting. A prior study of ten radiologists assessing chest radiographs with photographic IDs demonstrated that only two of the radiologists found the photographic IDs distracting [7]. Finally, 41 and 57 % of technologists anticipated spending more time in obtaining the radiographs or encountering technical or software issues with the new technology, respectively.…”

“…Integrating patients' digital facial photographs as identifiers (ID) with medical imaging (integrated photographic ID) [6] (Fig. 1) has been shown to increase the detection of mislabeled studies in adults [7,8]. Such photographs will not replace numerical identifiers, but rather supplement and strengthen identification.…”

A Novel Technology for Automatically Obtaining Digital Facial Photographs Near-Simultaneously with Portable Radiographs

“…Subsequently, through observer studies [4,5], we demonstrated that the addition of photographs to portable radiographs could significantly increase the detection rate of simulated wrong-patient errors. Note that our scheme will not prevent wrong-patient errors at the image acquisition level; rather, it is expected to lead to increased detection of such errors at the interpretation stage, thus resulting in decreased wrong-patient radiology reports.…”