After-hours imaging: 4 key takeaways from a survey of attending radiologists

Academic institutions traditionally rely on on-call radiology trainees to perform image interpretation during nights and weekends, but in recent years, attending-level radiologists have been called on more and more to perform these duties.

According to a recent study published in Current Problems in Diagnostic Radiology, attending radiologists think this trend is good for patient care, but they worry about its impact on the next generation of radiologists.  

Jason C. Hoffmann, MD, department of radiology at Winthrop-University Hospital in Mineola, N.Y., and colleagues surveyed more than 250 attending radiologists on the topic in June 2015. These are four of the survey’s most fascinating findings:

1. Most institutions already have 24-hour coverage provided by attending radiologists

Hoffman et al. noted that  24-hour attending radiologist coverage had jumped in recent years. In fact, according to a recent survey conducted by the American Alliance of Academic Chief Residents in Radiology, it increased from 15 percent in 2010 to 24 percent in 2014.

But the team’s own survey results revealed numbers that were even higher, with 69 percent of respondents saying their program has 24-hour attending radiologist coverage.

“This statistic is not surprising, as other studies have found that over the past few years, the number of programs across the country with 24/7 in-house radiology attending coverage has been increasing,” the authors wrote. “Another 21 percent of survey respondents reported having in-house attending coverage until at least 10 p.m. but not overnight. Thus, a total of 90 percent of respondents work at institutions with late or overnight attending or both in-house radiology coverage (at least 10 p.m. or 24/7).”

2. Most respondents said 24-hour attending radiologist coverage improves care

Seventy percent of the attending radiologists said putting attending radiologists in these roles improves patient care; 32 percent “strongly agreed” with this sentiment, another 38 percent “somewhat agreed.” Eighteen percent of respondents were neutral, however, and another 12 percent disagreed.

According to Hoffmann and the other researchers, patients in emergency rooms may benefit the most from this trend.

“The availability of accurate and rapid overnight attending reads is particularly beneficial to the emergency department, where a large number of clinical decisions are based on punctual and accurate imaging interpretations,” the authors wrote.

3. Many respondents said 24-hour attending radiologist coverage does not increase residents' learning

When asked if residents can learn more with attending radiologists providing final reads around the clock, 50 percent of respondents disagreed.

“Our finding is in contrast with previous studies, which indicate that resident teaching is enhanced by 24/7 attending coverage because of impromptu teaching opportunities and feedback sessions,” the authors wrote. “A potential explanation for this discrepancy may be related to increasing imaging volumes and the inherent conflict between the time needed to teach and the time needed for clinical duties. If there is a large volume of studies to read overnight, attending radiologists face a conflict between spending time teaching and making sure that studies are read quickly and accurately. This is magnified during the busiest times of the workday, which often are nights and weekends.”

In addition, 56 percent of respondents said this new trend is negatively affecting radiology residents.

“There is a clear concern among radiology attendings about the negative effect of 24-hour in-house attending coverage on resident autonomy,” the authors wrote.

One example of such an effect, the authors explained, is that some institutions require final reads within 30 minutes. This can lead to attending radiologists doing the work without involving the resident at all; the patient being cared for sees no ill effects, but the resident hoping to improve loses the opportunity to become better at his or her job.

4. When asked for additional comments, respondents wanted to discuss the negative impact of this trend

The survey gave attending radiologists the chance to provide additional comments about the topic at hand, and 85 respondents did just that. Of those responses, 69 percent “raised major concerns about the negative effect that overnight in-house radiology attending coverage is having on resident education.”

Decreased independence and worse preparation for the future were specific examples mentioned in the respondents’ answers.