Reducing our recall to assessment rate in the prevalent round to achieve the NHSBSP QA Standard

Since 1999, the proportion of prevalent round women recalled to assessment in the Liverpool NHSBSP has steadily increased – peaking at 17/1,000, almost double the minimum QA Standard. We have a total of 10 film readers and have always double-reported with arbitration (by a single radiologist). Our sensitivity has been good with an SDR and a small cancer detection rate within the target QA standard.

Factors perceived as problematic were the increasing number of readers, a high proportion of inexperienced readers, combinations of cautious readers and lack of discussion.

At the beginning of 2005 we adopted a new arbitration system. All prevalent round patients recalled by at least one film reader had their films reviewed by a minimum of three film readers, including at least one radiologist. This system was extended to include all incident round patients referred to arbitration. Recall rates and cancer detection rates were audited for 12 months.

We have now achieved a recall rate of 7.1/1,000 with no reduction in the cancer detection rate. Other benefits include an increased capacity in assessment clinics to accommodate age extension, reduced patient anxiety, better team working and a complimentary reduction in recall rates for incident round women.