Efficacy of a Checklist-Style Structured Radiology Reporting Template in Reducing Resident Misses on Cervical Spine Computed Tomography Examinations

The increasing use of medical checklists to promote patient safety raises the question of their utility in diagnostic radiology. This study evaluates the efficacy of a checklist-style reporting template in reducing resident misses on cervical spine CT examinations. A checklist-style reporting template for cervical spine CTs was created at our institution and mandated for resident preliminary reports. Ten months after implementation of the template, we performed a retrospective cohort study comparing rates of emergent pathology missed on reports generated with and without the checklist-style reporting template. In 1,832 reports generated without using the checklist-style template, 25 (17.6 %) out of 142 emergent findings were missed. In 1,081 reports generated using the checklist-style template, 13 (11.9 %) out of 109 emergent findings were missed. The decrease in missed pathology was not statistically significant (p = 0.21). However, larger differences were noted in the detection of emergent non-fracture findings, with 17 (28.3 %) out of 60 findings missed on reports without use of the checklist template and 5 (9.3 %) out of 54 findings missed on reports using the checklist template, representing a statistically significant decrease in missed non-fracture findings (p = 0.01). The use of a checklist-style structured reporting template resulted in a statistically significant decrease in missed non-fracture findings on cervical spine CTs. The lack of statistically significant change in missed fractures was expected given that residents’ search patterns naturally include fracture detection. Our findings suggest that the use of checklists in structured reporting may increase diagnostic accuracy.