Original article

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

Gwyn Weatherburn¹, Stirling Bryan², Anne Nicholas³ and Robert Cocks⁴

¹ Health Economics Research Group, Brunel University, Uxbridge, Middlesex UB8 3PH
² Health Services Management Centre, University of Birmingham, Birmingham
³ Accident and Emergency Department, Hammersmith Hospital, London
⁴ A&E Medicine Academic Unit, Cancer Centre, Prince of Wales Hospital, Shatin, New Territories, Hong Kong

Correspondence to:
Correspondence to: Gwyn Weatherburn (e-mail: gwyneth.weatherburn{at}brunel.ac.uk)

Objective—A study has been conducted to identify the benefits to the accident and emergency (A&E) department of a hospital wide Picture Archiving and Communications System (PACS).

Methods—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&E clinicians were compared with those made by radiologists. This resulted in the estimation of the incidence of false negative findings by the A&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.

Results—It was found that the overall rate of misdiagnoses across all A&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).

Conclusions—When PACS was used the diagnostic performance by A&E staff improved by reducing false negative interpretations but the rate of serious misdiagnosis did not change.

Keywords: PACS; misdiagnosis; radiography

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