Do Telephone Call Interruptions Have an Impact on Radiology Resident Diagnostic Accuracy?

Rationale and Objectives

The purpose of this study was to measure the effect of distractions, in the form of telephone call interruptions, on radiology resident diagnostic accuracy.

Materials and Methods

Radiology resident discrepancy reports and reading room telephone logs at an academic tertiary care pediatric hospital were collected over a 13-month period. Phone call times and durations were recorded. Major discrepancy shifts (defined as a call shift where at least one major discrepancy was discovered the following morning by the attending radiologist between the resident preliminary and attending final reports), and dictation time stamps for each discrepant preliminary dictation were also recorded. Telephone call volume and preliminary report time stamps were compared between “discrepancy shifts” and “no discrepancy shifts.”

Results

Each call shift spanned 14 hours, during which one radiology resident was responsible for the generation of preliminary interpretations. Review of the discrepancy log data revealed 51 major discrepancies in 41 shifts, of which 39 discrepancies had documented error details and resident preliminary report time stamps. The average number of telephone calls for the “discrepancy shifts” was slightly greater than the “no discrepancy shifts” (48.59 vs. 44.02) but was not statistically significant ( P = .0575). However, there was a statistically significant increase in the average number of phone calls in the 1 hour preceding the generation of a discrepant preliminary report versus the “no discrepancy shifts” (4.23 vs. 3.24 calls, P = .027). One additional phone call during the hour preceding the generation of a discrepant preliminary report resulted in a 12% increased likelihood of a resident error ( P = .017).

Conclusions

Distractions in the form of telephone call interruptions may negatively impact on-call radiology resident diagnostic accuracy. Efforts should be made to limit distractions in the reading room.

At many academic institutions, diagnostic radiology residents are often the sole practitioner responsible for after-hour radiology coverage, generating preliminary interpretations of examinations that are later reviewed and finalized by the attending radiologist. Radiology resident on-call responsibilities often require the ability to multitask, toggling between medical functions (interpreting examinations, interacting with consulting physicians and technologists, and consenting patients) and nonmedical functions (answering telephone calls and returning pages). The shifting of focus between multiple tasks has the potential to alter the resident’s mind-set with the potential for the introduction of medical errors.

Research and experience in complex “knowledge-intensive service environments” have shown that interruptions in workflow create inefficiencies, introduce barriers to productivity, and can contribute to errors . This is also true of the medical environment, a highly complex, cognitive-rich, service environment, with a great deal of attention and effort directed toward patient safety initiatives and health care system accountability . Prior research has linked interruptions with errors in the laboratory setting and clinical setting and the effect of interruptions on patient safety and workplace stress .

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Materials and methods

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Data Collection

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Data Analysis

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Results

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Table 1

Discrepancies by Imaging Modality and Body Region

Imaging Modality Chest Abdomen Extremity Genitourinary Tract Spine Pelvis Total Film 13 7 7 0 1 0 28 Computed tomography 3 2 1 0 1 1 8 Ultrasound 0 0 0 3 0 0 3 Total 16 9 8 3 2 1 39

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Discussion

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