Overnight Subspecialty Radiology Coverage: Review of a Practice Model and Analysis of Its Impact on CT Utilization Rates in Academic and Community Emergency Departments

Department of Radiology, University of Pittsburgh School of Medicine, Pittsburgh, PA 15213-2583, USA.
American Journal of Roentgenology (Impact Factor: 2.73). 09/2012; 199(3):623-6. DOI: 10.2214/AJR.11.8377
Source: PubMed


The purpose of this study is to describe a new practice model (overnight subspecialty radiology coverage) and to determine its impact on CT utilization rates in academic and community emergency departments.
Overnight subspecialty (neuroradiology and abdominal imaging) attending coverage was instituted at the University of Pittsburgh Medical Center in 2008. Previously, preliminary interpretations of CT studies performed at four academic emergency departments were provided by radiology residents. Interpretations were provided to five community emergency departments by either a senior resident or a contracted teleradiology service. Rotating shifts of neuroradiologists and abdominal imagers have since provided contemporaneous final reports for emergency department CT studies from 5:00 pm to 7:00 am. We compared total CT volume, emergency department visits, and CT "intensity" (CT volume / emergency department visits) within academic and community hospitals 12 months before and after institution of overnight coverage. We also compared on-call (5:00 pm to 7:00 am) and daytime CT intensity in academic and community emergency departments during these time periods.
Academic emergency department visits increased 7% and community emergency department visits decreased 3% during the study period. Total academic emergency department CT volume increased 8%, and community emergency department CT volume increased 9%. Daytime community emergency department CT volume remained constant, but on-call CT volume increased 16%. Academic emergency department CT intensity remained constant at 0.57, whereas community emergency department CT intensity increased from 0.40 to 0.45 (12.5%).
Institution of overnight subspecialty emergency department coverage resulted in a disproportionate increase in CT utilization in community emergency departments. We hypothesize that community emergency departments lacking in-house clinical subspecialists may be more apt to use subspecialist radiology interpretations for patient management. Overnight subspecialty coverage increases CT utilization in the community emergency department, but the appropriateness and clinical impact is uncertain and in need of exploration.

15 Reads
  • American Journal of Roentgenology 04/2013; 200(4):711. DOI:10.2214/AJR.13.10611 · 2.73 Impact Factor
  • [Show abstract] [Hide abstract]
    ABSTRACT: To compare programs with and without 24-hour/7 days a week/365 days a year (24/7/365) in-house radiologist coverage regarding resident perceptions of their on-call experience, volume of resident dictations on call, and report turnaround time. Residents from six academic radiology departments were invited to participate in an 11-item online survey. Survey items were related to workload, level of autonomy, faculty feedback, comfort level, faculty supervision, and overall educational experience while on call from 8 pm to 8 am. Each site provided data on imaging volume, radiologist coverage, volume of examinations dictated by residents, number of residents on call, and report turnaround time from 8 pm to 8 am. F-ratios and eta-squares were calculated to determine the relationships between dependent and independent variables. A P value < .05 was considered statistically significant. A total of 146 (67%) of 217 residents responded. Residents in programs with 24/7/365 in-house radiologist coverage dictated a lower percentage of examinations (46%) compared with other residents (81%) and rated faculty feedback more positively (mean 3.8 vs. 3.3) but rated their level of autonomy (mean 3.6 vs. 4.5) and educational experience (mean 3.6 vs. 4.2) more negatively (all P < .05). Report turnaround time was lower in programs with 24/7/365 coverage than those without (mean 1.7 hours vs. 9.1 hours). The majority of resident comments were negative and related to loss of autonomy with 24/7/365 coverage. More rapid report turnaround time related to 24/7/365 coverage may come at the expense of resident education.
    Academic radiology 04/2014; 21(7). DOI:10.1016/j.acra.2013.10.022 · 1.75 Impact Factor
  • [Show abstract] [Hide abstract]
    ABSTRACT: The objective of this study is to assess the impact of on-site attending radiologist overnight coverage on resident education during transition to 24/7 attending coverage. The study was exempted from IRB review. An anonymous survey was sent to 9 second year radiology residents who completed their first night call rotation (NC) with an attending radiologist (group 1) and 18 residents who completed their first NC prior to overnight attending coverage (group 2). This addressed anxiety level prior to NC, work pace, autonomy and confidence, and attending feedback, with responses graded on a five-point scale. Statistical analysis was performed using Spearman's rho correlation coefficient. Diagnostic Radiology In-Training (DXIT(TM)) exam scores were collected prior to and following completion of the NC rotation, and results were compared. Case volume before and after the transition was recorded. p value <0.05 indicated statistical significance. Eight out of nine residents in group 1 and 16 out of/18 residents in group 2 completed the survey. Group 1 was more likely to report working at a comfortable pace (p = 0.008) and receiving attending feedback (p = 0.004) than group 2. A non-significant trend towards reduced anxiety prior to NC was present in group 1 (p = 0.077). No difference in independence (p = 0.918), autonomy (p = 0.635), or confidence during (p = 0.431) or after NC (p = 1.00) was identified. DXIT(TM) scores were not significantly different between the two groups (p = 0.396). While overall case volume dictated by residents increased, fewer plain radiographs were dictated. Overnight attending coverage provides a more comfortable pace of study interpretation and increased attending feedback without decreasing resident independence or DXIT(TM) scores. Plain radiograph interpretation may need to be further emphasized.
    Emergency Radiology 06/2014; 22(1). DOI:10.1007/s10140-014-1246-9
Show more