Clinical audit of the completion of CT scan request forms

Inadequate Completion of Computed Tomography Request Forms of Patients Visiting the Department of Radiology and Imaging in a Tertiary Care Centre

Introduction

From both medical and legal points of view, it is vital that computed tomography request forms should be adequately filled up. It is the responsibility of physicians to collect adequate clinical information that justifies the computed tomography examination and the ethical responsibility of radiological technologists and radiologists is to perform only the justified radiological examinations. Thus, a properly filled request form is crucial for understanding the clinical problem, using the proper protocol for avoiding unnecessary radiation exposure and providing concise radiological reports. The aim of this study was to find out the prevalence of inadequate completion of computed tomography request forms of patients visiting the Department of Radiology of a tertiary care centre.

Methods

This descriptive study was performed in the Department of Radiology from 22 April 2021 to 21 April 2022 after receiving ethical approval from the Institutional Review Committee. Computed tomography request forms from emergency, ward and outpatient Departments were used in the study whereas that from other hospitals and clinics were excluded. A convience sampling method was used. The point estimate was calculated at a 95% Confidence Interval.

Results

Out of 470 computed tomography examination forms, the prevalence of inadequate computed tomography request forms was 195 (41.49%) (37.03-45.94, 95% Confidence Interval).

Conclusions

The prevalence of the inadequacy of completion of computed tomography examination forms was higher than other similar studies done in similar settings.

Keywords

audit; computed tomography; form.

Adequacy of completion of radiology request forms at St. Francis' Hospital of Katete District: A clinical audit in Zambia

Background

Most imaging examinations use ionising radiation which causes biological effects on the body. For this reason, only justified examinations should be requested by adequately completing the radiology request form (RRF) by clinicians. The RRF allows radiographers and radiologists to assess if the benefit outweighs the risk associated with medical radiation exposure. Inadequately or incorrectly filled RRFs leads to unnecessary radiation exposures, imaging errors, and delays in performing the examination. Therefore, this study aimed at auditing the adequacy of completion of general RRFs at St. Francis' Hospital of Katete District in Zambia.

Methods

This was a quantitative study in which RRFs for general radiography from January to December 2020 were audited. Data were collected retrospectively using a checklist from a total of 974 RRFs. The filled-in forms were assessed for completeness of information related to the patient, examination, and referring clinician. Data were analysed using descriptive statistics. The standard of completeness was based on the Royal College of Radiologists (RCR) guidelines requiring all the designated variables completed on the RRF.

Results

Most N=881(90.5%), RRFs were incompletely filled. With regards to patient's identification, the findings revealed N=4(0.5%), N=597(61.3%), N=3(0.4%), and N=2(0.3%) RRFs devoid of patient's name, hospital number, age, and gender, respectively. Regarding the examination, the findings revealed N=3(0.4%), N=68(7%), N=449(46.2%), and N=336 (37%) RRFs devoid of requested examination, indication, clinical history, and level of urgency, respectively. Regarding the referrer, the findings revealed N=135(13.9%), N=173(17.8 %), N=472(48.5%), and N=31(3.2%) RRFs were devoid of information relating to the ward, clinicians' name, referring department, and signature, respectively.

Conclusion

This audit reports that most of the RRFs were incompletely filled-in at St. Francis' Hospital. Furthermore, the hospital number, clinical history and level of urgency were the frequently unfilled variables. Overall, there were gaps in completion of RRFs requiring remedying.

Ethical impact of suboptimal referrals on delivery of care in radiology department

The referral is the key source of information that enables radiologists and radiographers to provide quality services. However, the frequency of suboptimal referrals is widely reported. This research reviews the literature to illuminate the challenges suboptimal referrals present to the delivery of care in radiology departments. The concept of suboptimal referral includes information, that is; missing, insufficient, inconsistent, misleading, hard to interpret or wrong. The research uses the four ethical principles of non-maleficence, beneficence, Autonomy and Justice as an analytic framework.Suboptimal referrals can cause harm by hindering safe contrast-media administration, proper radiation protection by justification of procedures, and compassionate patient care. Suboptimal referrals also hinder promoting patient benefits from the correct choice of imaging modality and protocol, an optimal performed examination, and an accurate radiology report. Additionally, patient autonomy is compromised from the lack of information needed to facilitate benefit-risk communication. Finally, suboptimal referrals challenge justice based on lack of reasonable patient prioritising and the unfairness caused by unnecessary examinations.These findings illuminate how suboptimal referrals can inhibit good health and well-being for patients in relation to safety, missed opportunities, patient anxiety and dissatisfaction. The ethical challenges identified calls for solutions. Referral-decision support tools and artificial intelligence may improve referral quality, when implemented. Strategies addressing efforts of radiology professionals are inevitable, including gatekeeping, shared decision-making and inter-professional communication; thereby raising awareness of the importance of good referral quality and promoting commitment to ethical professional conduct.