• Ingrid Klobasa, Gary Denham, Derek J Roebuck, Jenny Sim, Marilyn Baird, Dennis Petrie, Joshua Best, James Abood, Alexandra Tonks, Caitlin Tu, and Christopher Jones.
• Department of Medical Imaging and Radiation Sciences, School of Primary and Allied Health Care, Faculty of Medicine, Nursing and Health Sciences, Monash University, Melbourne, Victoria, Australia.
• Emerg Med Australas. 2024 Oct 9.

ObjectivesCritical/urgent X-ray findings are not always communicated in an appropriate time frame to ED physicians. The practice of radiographers alerting referrers to clinically significant image findings (verbally, via image flags or written comment) is noted internationally but risk assessment data is unavailable in the literature. A hybrid radiographer comment and alert model was piloted in New South Wales and a risk-benefit assessment conducted for timely and safe communication of abnormal X-ray appearances to ED physicians.MethodsRadiographer comments (n = 1102) were provided to five New South Wales EDs by 69 radiographers for a period of 3-12 months. Site auditors classified comments as true positive (TP), false positive (FP) or indeterminate (ID) with respect to the radiology report. FP comments were investigated with ED referrers and a low-medium-high-risk assessment was provided by two independent reviewers.ResultsA total of 42 FP (3.9%; 95% confidence interval [CI] 2.9-5.3) comments were analysed for any adverse outcomes. Risk assessments demonstrated 37 low, 5 low-moderate and no high-risk cases. A total of 282 direct or potential patient benefits were identified (26.4%; 95% CI 23.8-29.1). A total of 42 radiology report discrepancies were incidentally found: (3.9%; 95% CI 2.9-5.3). Audit results demonstrated areas where the radiographer comment could mitigate risk.ConclusionThe provision of radiographer alerts with a written comment for ED was found to be low risk to patients in the pilot study. Radiographers communicating directly with the emergency team when abnormal image appearances are detected can reduce diagnostic error and improve patient safety and health outcomes.© 2024 The Author(s). Emergency Medicine Australasia published by John Wiley & Sons Australia, Ltd on behalf of Australasian College for Emergency Medicine.

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