Document Detail


Radiology report clarity: a cohort study of structured reporting compared with conventional dictation.
MedLine Citation:
PMID:  20630384     Owner:  NLM     Status:  MEDLINE    
Abstract/OtherAbstract:
PURPOSE: The aim of this study was to determine if radiology residents who use a structured reporting system (SRS) produce reports of greater clarity than residents who use free-text dictation to report cranial MR imaging in patients with clinical suspicion of stroke.
METHODS: This double-cohort study included residents creating reports for 25 cranial MR imaging studies using an SRS in the intervention group and free text in the control group (report n = 1,685). Attending physicians from multiple subspecialties were surveyed seeking clarity ratings of randomly selected reports. Two neuroradiology fellows rated the clarity of 180 of the reports. Clarity ratings were analyzed by using Wilcoxon's signed-rank test for paired data and the Mann-Whitney U test for unpaired data.
RESULTS: Forty-three of 95 surveyed physicians returned completed surveys, with mean clarity ratings for SRS (4.9) and free-text (5.1) reports that did not differ significantly. Respondents' comments most often referred to confusing syntax, unfamiliar terms, or format preferences. Fellow raters rated the clarity of SRS reports lower than that of free-text reports (P < .001).
CONCLUSIONS: The use of an SRS to create MRI reports did not seem to improve or worsen attending physicians' perceptions of report clarity. Experience level may affect clarity-related report preferences. Future SRS should probably include definitions of key terms and be formatted to minimize syntactical errors.
Authors:
Annette J Johnson; Michael Y M Chen; Michael E Zapadka; Eric M Lyders; Benjamin Littenberg
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Publication Detail:
Type:  Comparative Study; Journal Article; Research Support, Non-U.S. Gov't    
Journal Detail:
Title:  Journal of the American College of Radiology : JACR     Volume:  7     ISSN:  1558-349X     ISO Abbreviation:  J Am Coll Radiol     Publication Date:  2010 Jul 
Date Detail:
Created Date:  2010-07-15     Completed Date:  2010-11-24     Revised Date:  -    
Medline Journal Info:
Nlm Unique ID:  101190326     Medline TA:  J Am Coll Radiol     Country:  United States    
Other Details:
Languages:  eng     Pagination:  501-6     Citation Subset:  IM    
Copyright Information:
Copyright 2010 American College of Radiology. Published by Elsevier Inc. All rights reserved.
Affiliation:
Department of Radiology, Wake Forest University Baptist Medical Center, Winston-Salem, North Carolina 27157, USA. anjohnso@wfubmc.edu
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MeSH Terms
Descriptor/Qualifier:
Cohort Studies
Humans
Medical Records / standards*
Peer Review, Health Care
Questionnaires
Radiology / methods*,  statistics & numerical data

From MEDLINE®/PubMed®, a database of the U.S. National Library of Medicine


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