SESSION TITLE: Cost and Quality Improvement Posters
SESSION TYPE: Original Investigation Poster
PRESENTED ON: Wednesday, October 29, 2014 at 01:30 PM - 02:30 PM
PURPOSE: Despite several established guidelines, interpretations of pulmonary function tests (PFTs) vary widely. Interpretations may lead to misclassification and misdiagnosis with potential implications for insurability. The variability may be due to training bias, use of non-standard guidelines, and physician fatigue. Reducing interpretative variability, by minimizing personal criteria and applying accepted guidelines, should improve diagnostic accuracy, reduce physician error, and improve overall health care.
METHODS: We performed a retrospective analysis of all 367 PFTs performed over a one-month period at two academic institutions. PFTs were interpreted by board-certified pulmonologists at Indiana University and Wishard Memorial Hospitals. Analysis was performed by two fellows and a senior attending physician, utilizing only the formatted results as seen by the interpreters. The following categories were analyzed: spirometries and associated flow-volume loops; static lung volumes; pulmonary diffusing capacity for carbon monoxide (DLCO); and arterial blood gases.
RESULTS: Of the 367 PFTs evaluated, we found errors or discrepancies of interpretation in 69 of the studies, or 18.8%. The greatest number of errors were found in the spirometry (22 ), flow-volume loop (11) and diffusing capacity (15).
CONCLUSIONS: Interpretation of pulmonary function tests is an integral and important task of a pulmonologist’s clinical practice. Despite guidelines from the American Thoracic Society, there remains considerable variability in interpretation of PFTs. This may result in missed and disputed diagnoses while potentially affecting the quality of trainee education in PFT interpretation.
CLINICAL IMPLICATIONS: Our analysis of our institutions’ PFT interpretations has resulted in multiple changes to the PFTs documentation requirements. Additionally, our findings suggest that significant misclassification may occur with the use of non-standard guidelines, and this may result in mistreatment of lung disease. We also suggest implementing a full-time attending and fellow during each block for interpretation and for fellow education.
DISCLOSURE: The following authors have nothing to disclose: Meghan McInerney, Matthew Nobari, Mark Farber
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