ARRS 2022 Abstracts

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E1320. Effective Integration of Community and Academic Radiology Practices into Emergency Department Workflow
Authors
  1. Jonelle Thomas; Penn State Health
  2. Michael Bruno; Penn State Health
  3. Kwasi Armah; Penn State Health
Objective:
Achieving the optimal level of resident supervision while serving the needs of patients and referring physicians in the Emergency Department (ED) setting is a challenge for academic radiology departments. It is important to maintain resident autonomy during ED night call rotations for education and preparation for independent practice. Although published resident-faculty discrepancy rates are consistently low, supporting the use of independent resident night call, there are times when an overnight final attending read may benefit patient care or ED disposition. Additionally, there are times that case volumes may exceed resident capacity, resulting in delays in image interpretation and patient care. The purpose of our study was to evaluate the effectiveness of integration of our community practice radiologists as final attending overreaders and overflow readers to support resident overnight rotations on an as-needed basis, with the goal of preserving the autonomous resident call experience.

Materials and Methods:
A member of our community radiology team is always available to interpret emergency studies at community hospital sites within our extended health system. We utilized a PACS-based workflow distributor tool to copy ED and stat inpatient radiographs from our “flagship” academic medical center onto the community radiologist worklist if the studies went unread by a resident for greater than 30 minutes. Cross-sectional imaging studies on ED and inpatients ordered as stat or priority were also duplicated on the community radiologist worklist after 60 minutes in completed status. The volume of distributed cases was monitored over a 4-week period. Final attending overread with discrepancy rates was recorded. Resident subjective feedback of the presence and educational value from an overnight community radiologist was obtained from residents assigned to night shift during the trial period. Report turn-around time (RTAT) before and after use of the community practice division was obtained for ED and inpatient studies.

Results:
Over a 4-week period, 504 studies total (mean of 18 per night) were filtered onto the community practice worklist. This included 330 plain films, 147 CT, 24 MR, and 3 US studies. Pre RTAT for ED plain films, CT, MR, and US was 359, 439, 587, and 343 minutes, respectively. Post RTAT for ED plain film, CT, MR, and US was 93, 217, 353, and 136 minutes, respectively. The discrepancy rate was < 1%. Resident subjective comments included the benefits of real-time feedback, potential for education, and improved ED attitude towards overread availability.

Conclusion:
Our experience serves as a proof-of-concept demonstrating the value of integrating community and academic radiologists to provide after-hours support and supervision of residents in an academic medical center while preserving resident autonomy to the fullest extent possible. Resident comments confirm preservation of the educational experience while improving RTAT and ED throughput.