Radiographer Preliminary Clinical Evaluation : a safe approach to reduce waiting times in Accident & Emergency?

Aim: The aim of this study was to evaluate the potential impact of radiographer red dot preliminary clinical evaluation on discharge delay for patients in the accident and emergency setting.

Method: Approved by the NHS hospital, a retrospective randomised sample was selected from a typical week (N=264 to give a 95% confidence level) to assess the accuracy of anonymised population of non-reporting radiographers (N=23) in appendicular image interpretation; comparing their actual decision with the radiologists official report. The time from x-ray to hospital discharge was also recorded.

Findings: The results demonstrated a radiographer image interpretation skills accuracy of 88%, with 75% sensitivity and 100% specificity. The ability to correctly identify true normal was excellent (100%) however 25 in every 100 fractures would statistically go undiagnosed. Foot and wrist were the largest source of error and are a recommended focus for CPD. X-ray to hospital discharge delay varied from 4 minutes to 4 hours with a mean of 1.02 hours.

Conclusion: Consistent with the vision of the College of Radiographers (2013) the results suggest that some radiographers are capable of providing reliable preliminary evaluation which could positively influence patient triage and waiting times in accident and emergency however others require further training, without which the implementation of any style of PCE would be unsafe. Further research is required to benchmark individual radiographer image interpretation performance and develop effective monitoring.