Using Point-of-Care Patient Photographs With Musculoskeletal Radiography to Identify Errors of Laterality in Emergency Department Imaging

Purpose: To evaluate the utility of point-of-care patient photographs accompanying musculoskeletal (MSK) radiography to identify errors in laterality. Materials and Methods: In this Institutional Review Board-approved study, 347 consecutive MSK radiograph-photograph combinations and corresponding radiography provider orders between October 1, 2018 and January 31, 2019, were retrospectively reviewed. Photographs were obtained simultaneously with the radiographs using the PatCam System (Camerad Technologies, Decatur, GA). In each case, laterality was recorded for all photographs, radiograph side markers, and radiography orders, and any laterality discrepancy among these variables was recorded. The side indicated on the provider order was taken as the gold standard. Results: Three hundred and forty-seven consecutive MSK radiograph-photograph combinations from 253 unique patients consisted of 129 upper extremity and 218 lower extremity radiographs. Two discrepancies (0.58%) in laterality were identified. The first discrepant case consisted of a left foot radiograph, which was labeled as "R" on the radiograph and left on the order. In this case, the patient photograph confirmed with certainty that the incorrect side marker was placed. The second discrepant case was a hip radiograph, in which 1 of 3 images had discrepant L/R labeling; the patient was covered with a sheet, both hips were included in the photograph, but a monitoring device on the patient's left side in the photograph also included on the radiographs determined which film was incorrectly labeled. Conclusions: Patient photographs obtained concurrently with MSK radiographs can provide a valuable quality tool in identifying errors of laterality. In our study, over 1 in 200 patients was identified as having such an error. (C) 2020 Published by Elsevier Inc.