5 minute read
Write First Time
from Inside News December 2021
by RANZCR
Minimising text errors in reports
Report bloopers like these can be quite entertaining—unless you are the patient, clinician or radiologist involved. Radiology communication errors occur after we have already examined the images carefully and interpreted findings correctly. They can lead to adverse outcomes for the patient and medicolegal strife for the radiologist, especially when reports are delayed or misdirected.
Textual mistakes like the cases above are usually less significant, but confusion about the meaning of the report can also derail timely treatment or subject patients to unnecessary procedures, including additional imaging. Resolving these issues generates extra work for radiologists, technologists and the department or practice as a whole. Reputations can be damaged, particularly with greater patient access to records and the rise of social media.
Studies find textual errors, variously defined, in anything from 5 to 60 per cent of reports, with an average of 1.6 to 1.7 errors per report. Most of these (around 80 per cent) do not cause major problems—they are typos, grammatical glitches or complete nonsense phrases that are obviously wrong to the reader. More serious issues may arise when words are omitted (particularly the word ‘no’), added or replaced resulting in a missense error—a plausible word or phrase with a different meaning from what was intended.
How we report also affects the risk of these types of errors. Historically, all reports were dictated by radiologists, typed by another staff member, then reviewed by the radiologist before release. Experienced transcriptionists frequently queried incorrect or unclear phrases. The main drawbacks of this system were longer report turnaround times and higher costs.
Voice recognition (VR) systems started to come into everyday practice in the early 2000s. Studies showed that while spelling mistakes and typos decreased, rates of certain errors, particularly soundalike word replacements like ‘brain’ for ‘drain’ and other missense errors, increased by factors of two or more; there has possibly been some improvement since then as the technology has matured.
When physicians type notes themselves, there may be even more mistakes. Many of these, however, are obvious typos. More recently, there has been a move toward templated or structured reporting, with largely or completely prepopulated text fields. Errors unique to template use include the inadvertent retention of prepopulated text or fields that contradict case-specific information entered by the radiologist.
Research evidence is still sparse, but suggests some improvement in error rate with template use, particularly in the frequency of missense errors. Some other interventions have been explored to reduce textual errors, including spelling and grammar checkers (which may not detect missense errors) and software that transfers image data such as measurements directly into the report, but this is not yet widely available. Report audit and feedback may also be beneficial.
Regardless of the report creation method—voice recognition, self-typing or templated, radiologists are now largely their own transcriptionists and editors, without the valuable proofreading step that expert typists once provided. Advice from the British Medical Journal in 2005 seems rather quaint now: ‘Good dictating skills are largely good manners. Stay polite and don't forget to say thank you from time to time’. In 2021, expressing thanks may not help radiologists improve reports as much as it once did, but we still have a number of other ways to reduce textual errors:
• Dictate and edit reports in a quiet space with minimal interruptions whenever possible; enunciate clearly.
• Use VR hardware and software with high-quality noise-cancelling technology.
• Take the time to train the VR software—and yourself. Most software defaults to American English spelling and pronunciation but this can be changed with training.
• Take the time to retrain words the VR software has trouble recognising.
• Train phrases rather than individual words: ‘No tumour’ rather than ‘no’ and ‘tumour’ separately.
• Use the auto-correct function (if available) for words that sound particularly similar when spoken quickly such as calcification and cavitation.
• Some software can be programmed to automatically generate predefined phrases when a keyword is dictated, for example, ‘PIRADS 2’ will appear as ‘PI-RADS 2 (clinically significant tumour is unlikely to be present)’.
• Plan your report outline, even when you are not using a template.
• Use wording that avoids ambiguity and problem areas for omissions, additions and replacement. Pertinent negatives are important in many clinical and imaging scenarios but findings can often be described positively: ‘normal diameter’ instead of ‘not dilated’.
• Consider using templates where available, but take care to select appropriately for the context, and to delete or edit any prepopulated sections that conflict with your findings and interpretation elsewhere in the report.
• Monitor your own reports to identify recurring problem words or phrases and consider alternatives.
• Proofreading is crucial—try not to skim read. Research shows that errors are reduced when there is a delay between text creation and editing/ review so the reader comes back to the text with fresh eyes. This is unfortunately not always practical, but may be particularly important for complex reports.
• Just as when you review images, pay attention to ‘check areas’ in the report text—laterality, measurements, units, negatives and wording highlighted by your past experience.
• A practice-wide report audit may be a worthwhile quality improvement project.
Structured Report Writing Group
Dr Felicity Pool | Chair
Dr Chian Chang
Dr Miranda Siemienowicz
