Factors associated with appointment non-attendance at a medical imaging department in regional Australia: a retrospective cohort analysis.

INTRODUCTION: Appointment non-attendance contributes added cost to the healthcare sector through wasted resource allocations. Medical imaging departments commonly schedule appointments for most modalities; however, no study has quantified patient attendance rates in the Australian regional setting. This is despite evidence that regional, rural and remote Australians tend to demonstrate poorer health than metropolitan counterparts. This study aims to identify the factors that influence appointment non-attendance at a teaching hospital in regional Australia. METHODS: Categories restricted to age, gender, indigenous status, distance from investigation site, referral source and imaging modality were collected for all appointments (N = 13,458) referred to the medical imaging department in 2015. The likelihood of each of these factors correlating with a patient not attending a scheduled appointment was calculated using the chi-squared analysis and binary logistic regression. RESULTS: Gender, indigenous status as well as specific imaging modalities, referral sources and age categories were significantly associated with non-attendance. Overall, male patients were 1.57 (P < 0.001) times more likely to miss a scheduled appointment than female patients. Patients who identified as Aboriginal and Torres Strait Islander were 2.66 (P < 0.001) times more likely to miss a scheduled appointment than patients who did not identify as Aboriginal and Torres Strait Islander. CONCLUSIONS: Several key factors appear to affect medical imaging appointment non-attendance. Key factors include indigenous status, gender, image modality, referral source and age. Further improvement is required to better meet the needs of underrepresented patient demographics.

The influence of a continuing education program on the image interpretation accuracy of rural radiographers.

INTRODUCTION: In regional, rural and remote clinical practice, radiographers work closely with medical members of the acute care team in the interpretation of radiographic images, particularly when no radiologist is available. However, the misreading of radiographs by non-radiologist physicians has been shown to be the most common type of clinical error in the emergency department. Further, in Australia few rural radiographers are specifically trained to interpret and report on images. This study aimed to evaluate the accuracy of a group of rural radiographers in interpreting musculoskeletal plain radiographs, and to assess the effectiveness of continuing education (CE) in improving their accuracy within a short time frame. METHODS: Following ethics approval, 16 rural radiographers were recruited to the study. At inception a purpose-designed 'test-object' of 25 cases compiled by a radiologist was used to assess image interpretation accuracy. The cases were categorised into three grades of complexity. The radiographers entered their answers on a structured radiographer opinion form (ROF) that had three levels of response - 'general opinion', 'observations' and 'open comment'. Subsequent to base-line testing, the radiographers participated in a CE program aimed at improving their image interpretation skills. After a 4 month period they were re-tested using the same methodology. The ROFs were scored by the radiologist and the pooled results analysed for statistically significant changes at all ROF levels and grades of complexity. RESULTS: While for the small number of less complex grade 1 cases there was no change in image interpretation accuracy, for the more numerous and more complex grade 2 and grade 3 cases there was a statistically significant improvement at the 'general opinion' and 'observation' levels (paired t-test, p < 0.05). Also, with the exception of the small sample of grade 1 cases, the proportion of cases correctly interpreted by the radiographers decreased as the ROF level, and therefore the amount of detail required, increased. CONCLUSIONS: This study had a number of methodological limitations but the results suggest that short-term, intensive CE programs can improve the ability of radiographers to accurately interpret plain musculoskeletal radiographic examinations. Similar, larger scale initiatives such as this could help reduce the risk of misdiagnosis in acute care settings, especially in the absence of a radiologist. However, radiographers' ability to use radiological vocabulary needs improvement. The complementary role that exists between radiographers and other members of the acute care team should be nurtured and developed in the context of declining numbers of radiologists, particularly in non-metropolitan areas. Intensive, short-term training in image interpretation may target junior medical officers, GPs and critical care nurse practitioners, as well as radiographers.