Having radiology residents read and pre-dictate overnight emergency CT scans, X-rays and ultrasounds slowed overall turnaround times by 11 to 49 minutes at a four-hospital academic medical system in a new study.
However, when the resident teams included experienced fourth-year trainees, the resident/attending pairs cut overall median report turnaround times by seven minutes versus attending-only efforts.
The research was conducted at Albert Einstein College of Medicine in New York City and is described in a study published Dec. 22 by Emergency Radiology [1].
Lead author Adina Scheinfeld, senior author Alain Cunqueiro, MD, and co-author Carly Schwartz, MD, emphasize that the study did not seek to gauge fourth-year resident accuracy and efficiency versus second- and third-year trainees.
Still, they note, preliminary reports prepared by less-experienced residents probably need more attention than reports from seasoned residents.
The authors cite prior research showing that, along with the time residents spend reading studies, unavoidable interruptions from clinicians and technologists tend to impede the sending of reports to attending radiologists for final signoff.
Mileage May Vary From One Institution to the Next
Commenting on the decreased turnaround times recorded when fourth-year residents were on duty versus nights when attendings worked solo, Scheinfeld and co-authors offer two possible explanations.
“First, resident facilitation of workflow and performing other on-call duties allows the attending to work more efficiently in parallel with the resident on other cases,” they write. “Second, well dictated and constructed resident reports may be signed off more rapidly than a report generated de novo by the attending.”
Meanwhile, fourth-year residents working with attendings reduced turnaround times for X-ray and CT during the study period—but the combo did not improve ultrasound workflow.
The authors suggest the discontinuity may owe to the way ultrasound are handled at their particular institution:
When a technologist finishes a case, the reading room is contacted to review the case to determine if the images are adequate before the patient is returned to the ED. If an attending is working alone, he or she will review the case with the technologist and dictate and sign the case immediately such that the ultrasound exam ‘jumps the line’ of potentially many radiograph and CT studies. This would markedly improve turnaround times for ultrasound exams when the attending is working alone, albeit delaying the reading of other exams which have been waiting for longer.”
‘Resident Education Is Fundamental’
Scheinfeld and colleagues conclude by underscoring their conviction that involving residents in real-world overnight reads sufficiently benefits ED radiology workflows and that resident education “should not be looked at as occurring to the detriment of case throughput.”
More:
Resident education is fundamental to the continuity of any medical specialty. All attendings were residents at the start of their careers, and robust training is necessary to ensure that the specialty remains vital. Strong focus on turnaround times has the potential to limit or cause the perception of limiting the number of cases available for residents to learn from, particularly among more junior residents. This of course must be balanced with proper supervision to prevent patient harm.”
The authors call for additional research at multiple centers to test their single-institution findings and to precisely delineate turnaround times between residents of differing experience levels.
The study is available in full for free.
Dave P. has worked in journalism, marketing and public relations for more than 30 years, frequently concentrating on hospitals, healthcare technology and Catholic communications. He has also specialized in fundraising communications, ghostwriting for CEOs of local, national and global charities, nonprofits and foundations.