Rationale and Objectives
With continued increase in imaging utilization and remote access image viewing technology, many academic radiology departments are presented with the suggestion to supplement on-call resident preliminary reports with an outsourced attending interpretation. This idea is often brought to administrative attention because of the subjective impression that outsourced studies will benefit from significantly faster interpretation times and lower discrepancy rates, especially when study volume is high. We attempt to retrospectively analyze on-call resident studies at a busy Trauma I university hospital and establish whether a statistical correlation exists among study volume, discrepancy rate, and turnaround time.
Materials and Methods
On-call computed tomography and ultrasound studies between January 2008 and June 2008 were retrospectively reviewed by blinded staff radiologists for discrepancies between preliminary and final reports. A correlation analysis between discrepancy rate and study volume per shift was performed. In addition, correlation analysis between volume per shift and interpretation time was also performed.
Results
A total of 1133 studies were reviewed. The major discrepancy rate is 1.85% with average turnaround time of 28.5 minutes. The correlation coefficient between major discrepancy rate and study volume is 0.35. The correlation coefficient between interpretation time and study volume is 0.29.
Conclusion
Our large retrospective review of preliminary reports from different residents reveals no significant correlation among discrepancy rate, turnaround time, and study volume. The overall discrepancy rate is similar to that reported by other studies. Other institutions can perform this study to analyze whether their volume and resident performance warrants supplemental assistance before depriving residents of the educational benefits the independent on-call experience affords.
Traditionally, most academic hospitals with a diagnostic radiology residency program have resident-only coverage for portions of the after-hours shift. The usual practice is to have the preliminary reports issued by the residents reviewed by an attending radiologist within a reasonable interval, usually within 12 hours. At the time of this secondary review, discrepancies are identified and the appropriate clinical services are notified. This system should be routinely reassessed by radiology departments to assure that residents with this autonomy are appropriately trained, the educational value of this experience is not overwhelmed by the volume of studies, and that patient care is not negatively affected .
Recently, many high-volume trauma level I academic institutions, such as ours, have been asked to evaluate the benefit of supplementing resident preliminary reports with outsourced radiology agency (ORA) reports during these after-hour shifts. The emergency department is often first to make this suggestion because many of their decisions are partially based on punctual and accurate imaging interpretations. In 2001, the American College of Radiology issued a resolution stating “all radiologic studies performed on emergency department patients should be promptly interpreted by radiologists .” To that end, outsourcing night coverage via teleradiology may conceivably improve the efficiency of coverage with multiple radiologists at a central source responsible for multiple hospitals. In addition, it has been suggested that outsourcing improves work efficiency during the day by allowing staff radiologists to get adequate rest at night . Putting cost, logistics, and educational issues aside, many assumptions are necessary to conclude that ORAs would benefit the emergency department significantly more than well-trained residents would. The major assumptions being that outsourced interpretations are more accurate, timely, and improve patient care.
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Materials and methods
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Results
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Table 1
Discrepancy and Time Data by Indication
Indication Number of Cases Major Discrepancy Rate (%) Minor Discrepancy Rate (%) Average Interpretation Time (minutes) Trauma 384 1.04 5.45 24.82 Nontrauma 749 2.27 14.95 30.34
Table 2
Discrepancy and Time Data by Study Type
Study Type Number of Cases Major Discrepancy Rate (%) Minor Discrepancy Rate (%) Average Interpretation Time (min.) CT abdomen and pelvis 468 2.51 18.41 35.78 CT cervical spine 121 0 4.13 20.22 CT chest 57 1.75 19.3 35.91 CTA chest 67 0 17.91 30.32 CT lumbar spine 17 0 23.53 17.24 CT neck 5 20 40 42 CT thoracic spine 15 0 0 19.87 CT head 352 1.39 3.6 21.66 US (all parts) 31 3.23 0 7.87
CT, computed tomography; CTA, CT angiography; US, ultrasound.
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Discussion
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