Questionable radiology read from outsourced group

[Midwest Medic]

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Last night I had a patient here with classis cholecystitis. Blood work was OK, did the ultrasound and showed gallbladder wall thickening with sludge and pericholecystic fluid. Classic for cholecystitis.... the radiology group called it normal GB ultrasound. Obviously this was not a normal scan though. My surgeon refused to admit this patient until he had a positive test though. I ended up admitting the patient for intractable vomiting and abdominal pain to the medicine service, but left a note on our in-house radiologist to read the US first thing in the AM. he made the correct read, and the patient went to surgery later in the day. Does anyone else outsource their night radiology and have any trouble with them? It has happened on occasion here, and I have started dictating their entire read, sometimes quoting about 4 pages of stuff, to cover myself. Sorry for the rant here, but this is a thorn in the side and seems nothing is being done about it.

 

[GeneralVeers]

It has happened on occasion here, and I have started dictating their entire read, sometimes quoting about 4 pages of stuff, to cover myself. Sorry for the rant here, but this is a thorn in the side and seems nothing is being done about it.

You have just illustrated why all of us need to look at every single study on our own in addition to the radiologist. I've caught a few oversights before, usually on trauma patients.

 

[southerndoc]

I'm lucky enough to have 24-hour attending reads on our CT's, ultrasounds, and MRI's. They stop reading plain films at 10p.

Where I work part-time, we have Nighthawk read CT's after midnight. We use the tech's interpretation of ultrasounds at night and inform patients of negative studies that they will be contacted by radiology in the morning if the radiologist disagrees with the tech (rarely happens).

When Nighthawk provides a preliminary read, their report is scanned in by the CT tech. It becomes part of the PACS system as a few pictures in line with the dose report and scout film.

 

[Midwest Medic]

We use Nightwawk as well, but their read disappears when our in house radiologist reads it. I have taken to putting their entire read in my dictation after being left out to dry on one case. After their read went away,it looked like I sent a man with a new lung mass home with antibiotics after they read it as a normal study. So, after that I dictate exactly what they say and their name, whether it be a 2 line read or 4 pages.

 

[Greenbbs]

we use a teleradiology firm for our overnights (usually midnight to 7am), and we've had a few questionable reads too. if you call them up (there's an 1-800 number), you can talk directly to the radiologist to discuss things, and if it needs to be corrected, they will send a correction.

 

[Aloha Kid]

I like the cover your butt reads by radiology.

Ex/ CTH: probable area of small calcification, although focal pinpoint hemorrhage could be possible in the right clinical setting. Recommend MRI for further detail.

Ex 2/ CT C-spine: Normal alignment without obvious fracture noted, however significant degenerative changes noted in the setting of a poor quality film. Please follow your trauma protocols. Ligamentous injuries cannot be ruled out, recommend further MRI imaging if clinically indicated.

 

[dmitrinyr]

I like the cover your butt reads by radiology.

Ex/ CTH: probable area of small calcification, although focal pinpoint hemorrhage could be possible in the right clinical setting. Recommend MRI for further detail.

Ex 2/ CT C-spine: Normal alignment without obvious fracture noted, however significant degenerative changes noted in the setting of a poor quality film. Please follow your trauma protocols. Ligamentous injuries cannot be ruled out, recommend further MRI imaging if clinically indicated.

I just finished doing a MICU month. Our radiologist use the old CYA method for even the basic CXR. Example: "Right lung showing a haziness in the area of RML atelectasis/infiltrate/consolidation. Correlate with clinical setting if applicable." Also, in a pt that had a pneumo and received a chest tube now waiting for the pneumo to resolve is NEVER read as "no pneumo" regardless of the fact that no pneumo can be seen by any MICU attending or senior resident.

 

[Apollyon]

One question is people saying "Nighthawks" are reading; is that actually "Nighthawks", or do you mean generic overnight groups that provide wet reads?

When I was a resident, we had the opposite going on - residents would read films, dictate in real time (voice recognition), and sign the read. We would go on what they'd seen. Then, next day, more than once, the attending read out with the resident, and the resident went in and changed the signed document (it's not like Ibex or Wellsoft, where, after you sign the chart, it's locked). The signed form now said "normal variant" or "unremarkable", and we looked like fools, going to the next step on something we believed to be a positive finding.

Where I'm at now, I have a radiologist in house 24 hours a day - CTs and ultrasounds are read all the time, plain films during business hours (unless we ask them to look at it - NEVER any heartburn about that), and MRIs at all hours (except once, because the rads guy said he didn't read them; made them get a neurorads guy to read it from home).

 

[southerndoc]

At my part-time hospital we use actual Nighthawk (the company). At my full-time hospital, the attendings take night shifts for a week and read everything except plain films (CT's, MRI's, ultrasound, etc.). Neuro stuff is overread by a neuroradiology attending the next day.

 

[Midwest Medic]

We use Nighthawk (the group) at both of my hospitals that we cover.

 

[Jeff698]

Our radiologists read all films in-house until 5pm or noon on weekends. After that, CT, MRI and US are sent via PACS to our academic center up the road where they're read by residents, then overread in the AM by our staff.

We never have radiology reads on plain films after hours.

Take care,
Jeff