Development of a checklist to enhance communication and reduce omission errors in interpretation of chest radiographs in resource-constrained settings

Abstract

Background: Currently, there is a universal shortage of radiologists, chest radiographs are extensively used by medical doctors to diagnose and monitor treatment and predict outcomes for many diseases and abnormalities. Chest radiographs are routinely used to manage complications associated with different types of chest diseases. Chest radiographs are challenging to interpret owing to overlapping clinical features and atypical presentations. There are many hospitals in South Africa where X-rays are performed; however, there is no structured method for interpretation. Aim: This study aimed to develop a checklist to enhance communication and reduce omission errors in the interpretation of chest radiographs in resource-constrained settings. Methodology: The researchers used a three-phased exploratory sequential mixed methodology to develop a quantitative checklist. In phase one, the results from the literature review were jointly displayed with recommendations from another qualitative study to form meta-inferences. The domains were operationalised and jointly displayed to build items for a preliminary qualitative checklist for chest interpretation. The researcher developed a draft survey tool. Phase two comprised a review of the preliminary checklist and survey tool. The checklist was further developed and validated by a panel of nine experts using the Delphi technique. In phase three, the developed quantitative standardisation, communication, image evaluation, and pattern recognition (SCIEPR) checklist, was sent for field testing. The survey tool was also validated by a biostatistician before use. 103 participants (40 radiographers and 63 medical doctors) in district hospitals were recruited to use the SCIEPR checklist in clinical settings. A cross-sectional study design was applied. Purposive sampling was used, and interested participants signed consent. Participants were given four weeks per hospital to use the checklist at least three times before taking part in the three-phase Likert scale survey. The survey validated the checklist's relevance, clarity, and duration to complete. The data from open and closed questions were analysed. Quantitative data were grouped and are presented as percentages in bar graphs. Qualitative data were analysed using content analysis. Codes were grouped into categories, and themes were identified to support the quantitative results. Results: Five themes emerged from Phase 1, namely, training, standardisation, communication, image evaluation, and pattern recognition, which were used to generate items for the development of the checklist. Phase 2 produced a 35-item checklist and a data collection survey tool. Phase 3 results included responses from 41 participants showing mostly positive responses. The SCIEPR checklist was deemed relevant, well-formatted, and clear. The constructs that scored highly scored were training (41), image evaluation (41), pattern recognition (39), standardisation (38), and communication (35). However, a few participants found the SCIEPR checklist to be time-consuming and did not recommend it for busy departments; however, such responses were from those who had used the checklist only once. According to the qualitative results, the checklist improved communication, patient diagnosis, image quality, evaluation of chest radiographs, and reduced patient waiting times. The checklist may improve hospital service. Conclusion: This study focused on the development and initial validation of the SCIEPR checklist. The SCIEPR checklist was validated for evidence of concept, face, and content validity. The findings of this thesis have significant implications for policy makers involved in improving service delivery in resource-constrained hospitals as well as curriculum developers involved in training medical practitioners and radiographers. The findings demonstrated that the SCIEPR checklist has significant potential for training medical practitioners, standardising chest image interpretation, and improving interprofessional collaboration and communication to reduce omission errors related to radiographs. Future research should implement the SCIEPR checklist in a larger field with a larger number of participants to provide additional evidence of construct and psychometric validity.