Overnight attending radiologists are handling more and more after-hours imaging—is that bad for radiology?
Many academic medical centers are shifting away from using radiology residents for after-hours imaging interpretations and turning to overnight attending radiologists instead, according to a new analysis published in Radiology. The authors suggested that this trend—which they don’t see reversing any time soon—could have some unintended negative consequences for radiology as a whole.
The analysis began with an exploration of how these medical centers have traditionally covered after-hours imaging: radiology residents making preliminary interpretations, with attending radiologist looking over their work the following morning.
“This so-called trainee-centered approach to patient care has been a part of the educational process since the first formal radiology residencies were established in the late 1930s and 1940s,” wrote author Michael A. Bruno, department of radiology at Penn State College of Medicine in Hershey, Pennsylvania, and colleagues. “Radiology residents are required to make independent decisions that have immediate effects on patient care, but have a safety net of a delayed second review and teaching input from the attending faculty in each subspecialty. In this model, the residents’ reports are not final because they are occasionally edited or even superseded by the subspecialist radiologist attending. The system of double reading with feedback is expected to lead to prompt detection of errors before they cause patient harm.”
This model, Bruno et al. explained, has been attacked in recent years due to fears that it slows down patient care or results in subpar patient care. The authors noted, however, that research has shown that double reading can result in less errors—and the double reading that occurs with a radiology resident handling after-hours interpretations would be lost with an overnight attending radiologist. In addition, they added, “dedicated attending coverage is typically associated with diminution or loss of subspecialty radiologist final review.”
The authors also examined various studies that have looked at the error rates of attending radiologists, finding that they are often similar—or even higher—than those of residents performing after-hours interpretations. And the team pointed out another potential problem with switching from residents to overnight attending radiologists: the negative impact it could have on the residents themselves.
“There is evidence to suggest that the loss of resident autonomy after hours is harmful to the educational mission in radiology, and this has been noted in other specialties,” Bruno and colleagues wrote.
Also, they noted that it could cost a significant amount of money and time to bring in overnight attending radiologists, since it requires finding several qualified radiologists who are comfortable working almost exclusively overnight.
Ultimately, the authors concluded, they feel that this trend is not going to slow down anytime soon, even if they worry about potential harm it could have on radiology as a whole.
“Despite our concerns and the evidence that supports them, we acknowledge that the observed trend away from the traditional resident coverage to an overnight 24/7 attending model will likely continue,” they concluded. “The transition to overnight attending radiologist coverage is also likely to be an irreversible one for most academic departments because the perception that it represents a higher standard of care will impede returning to the traditional model.”
Michael has more than 18 years of experience as a professional writer and editor. He has written at length about cardiology, radiology, artificial intelligence and other key healthcare topics.