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The costs and effects of introducing selectively trained radiographers to an A&E reporting service: a retrospective controlled before and after study

¹ York Trials Unit, Department of Health Sciences, University of York, York YO10 5DD, ² York Hospital, Wigginton Road, York YO31 8HE, ³ Department of Health Sciences, University of York, York YO10 5DD, ⁴ The Queen Elizabeth Hospital, Gayton Road, Norfolk PE30 4ET and ⁵ The Derwent Practice, Norton Road, Malton YO17 9RF, UK

The costs and effects of introducing selectively trained radiographers reporting accident and emergency (A&E) radiographs of the appendicular skeleton in a district general hospital were assessed using a retrospective controlled before and after design. Reference standard reports were compared with a random stratified sample of 200 A&E and 200 general practitioner (GP) reports before and after the intervention. GP reports were used as a non-intervention, non-equivalent control group. An A&E specialist registrar judged whether incorrect A&E reports might have a clinically important effect on patient management. The effect of incorrect A&E reports on outcome was assessed by patient re-attendance to the hospital because of missed abnormalities. The annual, average and incremental costs of radiographers and radiologists reporting A&E radiographs were calculated and a sensitivity analysis was undertaken. The introduction of the radiographers resulted in a 1% (95% CI –7.9 to 5.9) fall in A&E radiograph reporting accuracy and 11% (95% CI –33.7 to 11.3) reduction of cases in which incorrect A&E reports might have a clinically important effect on patient management. Only two A&E reports (one before and one after the intervention) affected patient outcome in that a fracture missed at the first visit resulted in patient re-attendance to the X-ray Department. There was a saving of £361 per annum to the X-ray Department. In conclusion this study provides further evidence that selectively trained radiographers can accurately report A&E plain radiographs and at no additional cost.

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