The effect of a Picture Archiving and Communications System (PACS) on diagnostic performance in the accident and emergency department

TLDR

The study aimed to determine the benefits of implementing a hospital‑wide PACS in the A&E department. The study compared A&E clinicians’ radiographic diagnoses during conventional film use and during PACS operation, estimating false‑negative rates and assessing treatment changes. PACS use reduced overall misdiagnosis rates from 1.5 % to 0.7 % (significant), but the rate of serious misdiagnoses requiring patient recall did not change.

Abstract

<i>Objective</i>—A study has been conducted to identify the benefits to the accident and emergency (A&amp;E) department of a hospital wide Picture Archiving and Communications System (PACS). <i>Methods</i>—The study was conducted in two parts: firstly while the hospital was using conventional radiographic films, and secondly when the PACS was in operation. For each part of the study, the diagnoses of radiographic images made by A&amp;E clinicians were compared with those made by radiologists. This resulted in the estimation of the incidence of false negative findings by the A&amp;E staff. The management of patients with such findings was studied to identify those for whom a change of treatment was required. Such data for the two periods, when film and when PACS was used, were compared. <i>Results</i>—It was found that the overall rate of misdiagnoses across all A&amp;E patients who had radiography was low in both periods and there was a significant reduction when PACS was used (1.5% for film and 0.7% for PACS, 95% CI for difference between proportions: −0.014 to −0.0034), but the rate of serious misdiagnoses involving patient recall did not change significantly (95% CI for difference between proportions: −0.0059 to +0.0001). <i>Conclusions</i>—When PACS was used the diagnostic performance by A&amp;E staff improved by reducing false negative interpretations but the rate of serious misdiagnosis did not change.