Radiology Residents And Turnaround Time in the ED
Research conducted at Albert Einstein College of Medicine in New York City sought to discover what effects, if any, were caused by the use of radiology residents during overnights in their ED departments. The study was led by Adina Scheinfeld (lead author), senior author Alain Cunqueiro, MD, and co-author Carly Schwartz, MD.
The retrospective study reviewed data from the hospital system where two scenarios are utilized for overnight coverage in their ED departments.
- One overnight attending covers two hospitals with a 2nd/3rd-year overnight resident
- Overnight attending covers two other hospitals 80% of the time independently and 20% of the time with a fourth-year resident
The first part of their study calculated the median difference in turnaround time — from when the technologist completed the radiology exam to when the attending finalized the report, comparing cases read independently by attendings and pre-dictated by residents.
In the second portion of the study, researchers calculated the median difference in turnaround time for all cases at the second set of hospitals between the nights when an attending was on duty and the nights when a fourth-year resident was also on duty, regardless of if the resident had pre-dictated the case.
Utilizing the data for computed tomography (CT), radiographs (XR), and ultrasound (US), there were substantial delays for patient studies pre-dictated by residents compared to cases read independently by attendings — ranging from 11 to 49 minutes depending on resident seniority and modality.
Yet a decrease of 7 minutes in overall median report turnaround time appeared on nights when a 4th-year resident working.
Emergency department metrics are critical to maintaining high levels of care and timely patient throughput. Especially during periods of high utilization, radiologic studies may be one of the reasons for slow times for patient throughput. Many studies require patients to drink oral contrast, imaging times are longer for MRI and US studies, and extended waiting times caused by high patient counts.
Their study notes,
“Having a resident work with an attending overnight may have both positive and negative impacts on report turnaround time. When residents pre-dictate cases, additional time must be spent for the resident to review the case, identify the findings, incorporate findings into the report, and synthesize the impression. The attending must then review the images, edit the resident report, and finally sign the report. Discrepancies or teaching points may also be discussed with the resident, which may further increase turnaround time.”
Yet, their study emphasizes the time-saving aspects of having residents provide assistance,
“Residents may assist by giving preliminary interpretations for inpatient exams (“wet reads”), protocolling cases appropriately, performing emergency procedures (such as fluoroscopy or ultrasound), assisting radiology technologists and nurses with questions regarding safety or technical quality of exams, and coordinating consults for interventional or pediatric radiology.”
The only improvement not seen when utilizing fourth-year residents was for ultrasound examinations. The study team noted that the methodology for ultrasounds might account for longer turnaround times at their facility, and probably other facilities too.
“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 US 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.”
Radiology residents’ education in clinical settings is essential. Too strong a focus on turnaround times could lead to limiting or causing the perception of limiting “the number of cases available for residents to learn from, particularly among more junior residents.”
The study team concludes that resident pre-dictation can slow down reading times for individual reports when compared to readings performed by faulty. But they also point out two positive outcomes:
- With fourth-year residents, there is a significant improvement in report turnaround time.
- Resident involvement substantially benefits ED patient workflow and resident education.
The authors suggest that other institutions conduct individual studies to determine if these results hold at their sites and if workflow benefits are seen for second and third-year residents.