To study the impact of 24/7/365 attending radiologist coverage on the turnaround time (TAT) of trauma and nontrauma cases in an emergency and trauma radiology department.
Patients and Methods:
This was a retrospective chart review in which TAT of patients coming to the emergency department between 2 periods: (1) December 1, 2012, to September 30, 2013, and (2) January 1, 2017, to January 30, 2018, and whose reports were read by an attending emergency and trauma radiologist was noted.
Results:
The 24/7/365 radiology coverage was associated with a significant reduction in TAT of computed tomography reports, and the time reduction was comparable between trauma and nontrauma cases. In adjusted models, the extension of radiology coverage was associated with an average of 7.83 hours reduction in overall TAT (95% confidence interval [CI]: 7.44-8.22) for reports related to trauma, in which 2.73 hours were due to reduction in completion to transcription time (TC; 95% CI: 2.53-2.93), and 5.10 hours were due to reduction in transcription to finalization time (TF; 95% CI: 4.75-5.44). For reports related to nontrauma cases, 24/7/365 coverage was associated with an average of 6.07 hours reduction in overall TAT (95% CI: 3.54-8.59), 2.91 hours reduction in TC (95% CI: 1.55-4.26), and 3.16 hours reduction in TF (95% CI: 0.90-5.42).
Conclusion:
Our pilot study demonstrates that the implementation of on-site 24/7/365 attending emergency radiology coverage at a tertiary care center was associated with a reduced TAT for trauma and nontrauma patients imaging studies. Although the magnitude and precision of estimates were slightly higher for trauma cases as compared to nontrauma cases. Trauma examinations stand to benefit the most from 24/7/365 attending level radiology coverage.
LambLKashaniPRyanJ, et al.Impact of an in-house emergency radiologist on report turnaround time. CJEM. 2015;17(1):21–26.
3.
HannaTNRohatgiSShekhaniHNDaveIAJohnsonJO. Clinical information available during emergency department imaging order entry and radiologist interpretation. Emerg Radiol. 2017;24(4):361–367.
4.
RosenkrantzABBonavitaJAForanMPMatzaBWMcMenamyJM. Is there an association between radiologist turnaround time of emergency department abdominal CT studies and radiologic report quality?Emerg Radiol. 2014;21(1):5–10.
5.
FolioLR. Combat Radiology: Diagnostic Imaging of Blast and Ballistic Injuries. Springer Science & Business Media; 2010.
6.
RouhaniSAEliacinHCEdmondMCCheckettKARimpelLMarshRH. Epidemiology of traumatic injuries presenting to an ED in central Haiti: a retrospective cohort study. Emerg Med J. 2019;36(7):389–394.
7.
WangHNaghaviMAllenC, et al.Global, regional, and national life expectancy, all-cause mortality, and cause-specific mortality for 249 causes of death, 1980-2015: a systematic analysis for the global burden of disease study 2015. Lancet. 2016;388(10053):1459–1544.
8.
GunnAManganoMPugmireBSahaniDBinderWChoyG. Toward improved radiology reporting practices in the emergency department: a survey of emergency department physicians. J Radiol Radiat Ther. 2013;1(2):1013.
HannaTNLamoureuxCKrupinskiEAWeberSJohnsonJO. Effect of shift, schedule, and volume on interpretive accuracy: a retrospective analysis of 2.9 million radiologic examinations. Radiology. 2017;287(1):205–212.
11.
FairbanksRGuarreraTBisantzAVenturinoMWestessonP, eds. Opportunities in IT support of workflow & information flow in the emergency department digital imaging process. In: Proceedings of the Human Factors and Ergonomics Society Annual Meeting. Los Angeles, CA: Sage; 2010.
12.
DeFlorioRCoughlinBCoughlinR, et al.Process modification and emergency department radiology service. Emerg Radiol. 2008;15(6):405–412.
13.
FischerHW. Better communication between the referring physician and the radiologist. Radiology. 1983;146(3):845–856.
14.
BerlinLM. Failure of radiologic communication: an increasing cause of malpractice litigation and harm to patients. Appl Radiol. 2010;39(1):17.
15.
BolandGGuimaraesAMuellerP. Radiology report turnaround: expectations and solutions. Eur Radiol. 2008;18(7):1326–1328.
16.
BolandGW. Stakeholder expectations for radiologists: obstacles or opportunities?J Am Coll Radiol. 2006;3(3):156–163.
17.
KushnerDCLuceyLL. Diagnostic radiology reporting and communication: the ACR guideline. J Am Coll Radiol. 2005;2(1):15–21.
18.
SistromCLLanglotzCP. A framework for improving radiology reporting. J Am Coll Radiol. 2005;2(2):159–167.
19.
ThrallJH. Reinventing radiology in the digital age: part II. New directions and new stakeholder value. Radiology. 2005;237(1):15–18.
20.
BranstetterIVBF. Basics of imaging informatics: Part. Radiology. 2007;243(3):656–667.
21.
StrifeJLKunLEBeckerGJDunnickNRBosmaJHatteryRR. American Board of Radiology Perspective on Maintenance of Certification: Part IV—Practice Quality Improvement for Diagnostic Radiology. Radiographics. 2007;27(3):769–774.
22.
BodanapallyUKShanmuganathanKNutakkiKMirvisSESlikerCWShetN. Implementation of 24/7 radiology services in an academic medical centre level 1 trauma centre: impact on trauma resuscitation unit length of stay and economic benefit analysis. Injury. 2013;44(1):75–79.
23.
SnaithBHardyM. The perceived impact of an emergency department immediate reporting service: an exploratory survey. Radiography. 2013;19(2):92–96.
24.
BengerJLyburnI. What is the effect of reporting all emergency department radiographs?Emerg Med J. 2003;20(1):40–43.
25.
Healthcare Commission. An Improving Picture? Imaging Services in Acute and Specialist Trusts. London, United Kingdom: Acute Hospital Portfolio Review; 2007:1–48.
GoehlerAGazelleGS. Examining the use of comparative and cost-effectiveness analyses in radiology. AJR Am J Roentgenol. 2014;203(5):939–944.
28.
HardyMSnaithBScallyA. The impact of immediate reporting on interpretive discrepancies and patient referral pathways within the emergency department: a randomised controlled trial. Br J Radiol. 2013;86(1021):20120112.
29.
SprivulisPFrazerAWaringA. Same-day X-ray reporting is not needed in well-supervised emergency departments. Emerg Med. 2001;13(2):194–197.
30.
HirschornDSHinrichsCRGorDMShahKVisvikisG. Impact of a diagnostic workstation on workflow in the emergency department at a level I trauma center. J Digit Imaging. 2001;14(1):199–201.
31.
NewgardCDFleischmanRChooE, et al.Validation of length of hospital stay as a surrogate measure for injury severity and resource use among injury survivors. Acad Emerg Med. 2010;17(2):142–150.
32.
SouthallACHarrisVV. Patient ED turnaround times: a comparative review. Am J Emerg Med. 1999;17(2):151–153.
33.
RobinsonJDHippeDSDecondeRZecevicMMehtaN. Emergency radiology: an underappreciated source of liability risk. J Am Coll Radiol. 2020;17(1):42–45.
34.
WilliamsSMConnellyDJWadsworthSWilsonDJ. Radiological review of accident and emergency radiographs: a 1-year audit. Clin Radiol. 2000;55(11):861–865.
35.
WallsJHunterNBrasherPMHoSG. The DePICTORS Study: discrepancies in preliminary interpretation of CT scans between on-call residents and staff. Emerg Radiol. 2009;16(4):303–308.
36.
SpitlerKVijayasarathiASalehiB, et al.24/7/365 neuroradiologist coverage improves resident perception of educational experience, referring physician satisfaction, and turnaround time [published online October 9, 2018]. Curr Probl Diagn Radiol. doi:10.1067/j.cpradiol.2018.09.004.
37.
DabboSVarnerCBleakneyROvensH. Clinical impact of extending after-hours radiology coverage for emergency department computed tomography imaging. Open Access Emerg Med. 2014;6:33.
38.
RajaFSAmannJ. After-hours radiology consultation in an academic setting, 2005-2009. Can Assoc Radiol J. 2012;63(3):165–169.
39.
NishisakiAPinesJMLinR, et al.The impact of 24-hr, in-hospital pediatric critical care attending physician presence on process of care and patient outcomes. Crit Care Med. 2012;40(7):2190–2195.
40.
KrupinskiEABerbaumKSCaldwellRTSchartzKMKimJ. Long radiology workdays reduce detection and accommodation accuracy. J Am Coll Radiol. 2010;7(9):698–704.
41.
ChungJHStrigelRMChewARAlbrechtEGunnML. Overnight resident interpretation of torso CT at a level 1 trauma center: an analysis and review of the literature. Acad Radiol. 2009;16(9):1155–1160.
42.
RuutiainenATScanlonMHItriJN. Identifying benchmarks for discrepancy rates in preliminary interpretations provided by radiology trainees at an academic institution. J Am Coll Radiol. 2011;8(9):644–648.
43.
StevensKJGriffithsKLRosenbergJMahadevanSZatzLMLeungAN. Discordance rates between preliminary and final radiology reports on cross-sectional imaging studies at a level 1 trauma center. Acad Radiol. 2008;15(10):1217–1226.
44.
CarneyEKempfJDeCarvalhoVYuddANosherJ. Preliminary interpretations of after-hours CT and sonography by radiology residents versus final interpretations by body imaging radiologists at a level 1 trauma center. AJR Am J Roentgenol. 2003;181(2):367–373.
45.
JalalSLloydMEKhosaFHsuGINicolaouS. Exploratory data analysis for pre and post 24/7/365 attending radiologist coverage support in an emergency department: fundamentals of data science [published online December 16, 2019]. Emerg Radiol. doi:10.1007/s10140-019-01737-5.
