Clinicians' perceptions of the quality of outsourced radiology and actions taken around perceived imaging errors in practice.

OBJECTIVES: Outsourcing of radiological reporting services has fundamentally altered communication between radiologists and clinicians in clinical decision making, which relies heavily on diagnostic imaging. The aim of this study was to understand clinicians' perspectives and experiences of interpretation of outsourced reports in clinical practice, if the author of imaging reports matters to clinicians, and actions taken to deal with perceived errors. METHODS: A printed survey was distributed to a purposive sample of 50 of the 250 senior medical and surgical staff of a large National Health Service hospital in the UK who regularly engaged with the Radiology Department between May and October 2017, representing 20% of this hospital workforce. The survey consisted of ten questions examining clinicians' opinions on radiology reporting, with comment options to encourage respondents to give further detail. Participants were requested to return the survey to the study investigators. RESULTS: The survey elicited a 100% response rate (n = 50). A constant comparative framework was used to guide analysis, revealing themes relevant to the ongoing inter-professional relationship between clinicians and radiologists. The disparity between in-house and externally sourced radiology reports and underlying issues of trust surrounding outsourced reports were the most significant themes identified. CONCLUSIONS: This study found outsourcing of radiology reporting needs multi-disciplinary team availability regarding the interpretation and discussions around capacity for effective communication. It raises important issues around often under-acknowledged additional workloads imposed on in-house radiologists. There are financial and pragmatic clinical aspects in pathways of radiology practice which require further research and examination. KEY POINTS: • Utilisation of outsourcing is increasing in practice in response to imaging demands. • Outsourcing increases departmental primary reporting capacity but may increase the workload of the local radiologist. • The development of strategies for outsourcing examinations may lessen demands on the in-house workforce.

Characterising women with obstetric fistula and urogenital tract injuries in Tanzania.

INTRODUCTION AND HYPOTHESIS: World Health Organisation (WHO) data suggest that more than two million women and girls live with fistula and that an additional 50-100,000 are newly affected each year. In Tanzania, it has been estimated that there are between 1,200 and 3,000 new cases of obstetric fistula annually. METHODS: To characterize women undergoing surgery in 2011 for obstetric fistula repair at a disability hospital associated with Comprehensive Community Based Rehabilitation in Tanzania (CCBRT), we identified routinely collected data and input into an Access database. RESULTS: Women affected by obstetric fistulae in Tanzania are frequently young, poorly educated, primiparous, subsistence farmers or housewives and have experienced obstructed labour as a result of delays occurring at home and/or after reaching a health facility. The majority experienced stillbirth, particularly in cases of assisted or operative delivery. Success rates for fistula closure were high, at 91 %, but residual incontinence on discharge from hospital was seen in 39 %. CONCLUSIONS: Longer-term follow-up is required to determine rates of disabling residual incontinence and to examine demographics in greater depth, including variation between regions and in urban, periurban and rural settings in Tanzania.

Psychosocial impact of obstetric fistula in women presenting for surgical care in Tanzania.

INTRODUCTION AND HYPOTHESIS: World Health Organisation data suggest that two million women live with the physical and psychosocial effects of obstetric fistula. As part of an expanded fistula programme in Tanzania, Comprehensive Community Based Rehabilitation in Tanzania (CCBRT) introduced an evaluation strategy to include impact of surgery on psychosocial aspects of obstetric fistula. This is an initial report documenting morbidity on admission. METHODS: A questionnaire assessing the impact of obstetric fistula was developed taking into account literature in the field including sections on: patient contact information, transport costs and a set of statements regarding the effects of fistula. The effects were spread across five domains: the physical consequences of obstetric fistula, the effects of a difficult delivery and possible stillbirth, the experience of isolation, the inability to undertake daily living activities and feelings of depression. The questionnaire was administered in Kiswahili by Tanzanian counsellors shortly after admission of patients onto the fistula ward. RESULTS: A total of 100 fistula patients reported high rates of physical and psychosocial morbidity. Over half of the patients said they would not have been able to access treatment without the transport costs being covered. CONCLUSIONS: Fistula patients are affected by extremely high rates of physical and psychosocial morbidity. Further work is required to confirm these findings, validate assessment tools and assess contributing factors in greater detail over time, such as the effect of stillbirth, as well as the impact of surgery.