Towards task shifting? A comparison of the accuracy of acute trauma-radiograph reporting by medical officers and senior radiographers in an african hospital

Abstract

IntroductionDue to the universal shortage of radiologists, medical officers are largely responsible for acute trauma radiograph reporting in public sector healthcare facilities in well-resourced countries. In poorly-resourced countries, a shortage of medical officers results in most acute trauma radiographs being unreported. In the European Union (EU), experienced radiographers with no specific training have been shown to be more accurate than medical officers in trauma radiograph reporting, while EU radiographers who receive additional training can reach accuracies comparable to radiologists. In some EU countries, the role of the radiographer has been extended to include trauma reporting. However, there has been no study of the accuracy of trauma radiograph reporting by radiographers in Africa, where task-shifting could yield potentially greater benefits, due to shortages of both radiologists and medical officers. The aim of this study was therefore to compare the accuracy of acute trauma-radiograph reporting by medical officers and senior radiographers in an African settingMethodsA prospective study was conducted at a South African hospital from November 2013-April 2014. Medical officers and senior radiographers reported the same set of appendicular skeleton trauma radiographs. Reporting accuracy, sensitivity and specificity were calculated using a consultant radiologist's report as the reference standard. Differences were evaluated using the Mann-Whitney U test, with p < 0.05 significantResultsSenior radiographers achieved significantly higher reporting accuracy and sensitivity than medical officers (81.5% vs 67.8%, p = 0.002)ConclusionSenior radiographers represent a potentially important resource for acute trauma-radiograph reporting in the public healthcare sector in Africa.

Reporting of Trauma-related Radiographic Images in After-hours Trauma Units: Experiences of Radiographers and Medical Practitioners in the Eastern Cape, Republic of South Africa

“…Gqweta [22] argues that at times a lack of resources means a lack of skilled, qualified, and experienced personnel rather than finances, hence the shift in responsibility to the junior and inexperienced personnel to make decisions. Literature underscored the universal shortage of radiologists in South Africa, as well as the demands the current context places on radiographers to assume roles beyond their traditional roles [8,10]. du Plessis and Pitcher [8] argue that some form of task-shifting will be required in the future to meet the demands of the health system in South Africa and facilitate more equitable access to health services.…”

“…Literature underscored the universal shortage of radiologists in South Africa, as well as the demands the current context places on radiographers to assume roles beyond their traditional roles [8,10]. du Plessis and Pitcher [8] argue that some form of task-shifting will be required in the future to meet the demands of the health system in South Africa and facilitate more equitable access to health services. Etheredge [26] highlights that South African radiographers find themselves in a precarious situation when no radiologist is available and they are faced with a request for assistance or opinion, even from patients.…”

“…A recent South African study by du Plessis and Pitcher concluded that radiographers can potentially fulfil important supportive and clinical roles, particularly in the public sector (ie, government) controlled health care establishments [8]. A study by Kelly et al [9] also found that collaboration between medical practitioners and radiographers improved the medical practitioners' accuracy of diagnosis and improved patient care management.…”

“…Another South African study by Hlongwane and Pitcher [5] demonstrated that the quality of reports produced by radiographers on general trauma radiographs are comparable with those of radiologists. It was also found that radiographers, when interpreting acute-trauma radiographs, achieved significantly greater reporting accuracy and sensitivity than medical practitioners [5][6][7][8]. The accuracy and sensitivity by radiographers was achieved, without additional training, in both written reports and using the reddot system.…”

Diagnostic reference levels in low- and middle-income countries: early “ALARAm” bells?

“…Task shifting is a method of expanding the health workforce by delegating work from more-to less-specialized healthcare workers who can competently perform the task. There is growing realization that some form of task shifting will be required at many levels of healthcare in the future, to facilitate more equitable access to services (34,35). This study was limited by being confined to Englishlanguage articles, with the attendant potential for under-reporting, given the language diversity within LMICs.…”