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Availability of a final abdominopelvic CT report before emergency department disposition: risk-adjusted outcomes in patients with abdominal pain. Abdom Radiol (NY) 2021; 46:2900-2907. [PMID: 33386916 DOI: 10.1007/s00261-020-02899-4] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/03/2020] [Revised: 11/24/2020] [Accepted: 12/04/2020] [Indexed: 10/22/2022]
Abstract
OBJECTIVE To determine whether availability of a final radiologist report versus an experienced senior resident preliminary report prior to disposition affects major care outcomes in emergency department (ED) patient presenting with abdominal pain undergoing abdominopelvic CT. MATERIALS AND METHODS This single-institution, IRB-approved, HIPAA-compliant retrospective cohort study included 5019 ED patients with abdominal pain undergoing abdominopelvic CT from October 2015 to April 2019. Patients were categorized as being dispositioned after either an experienced senior resident preliminary report (i.e., overnight model) or the final attending radiologist interpretation (i.e., daytime model) of the CT was available. Multivariable regression models were built accounting for demographic data, clinical factors (vital signs, ED triage score, laboratory data), and disposition timing to analyze the impact on four important patient outcomes: inpatient admission (primary outcome), readmission (within 30 days), second operation within 30 days, and death. RESULTS In the setting of an available experienced senior resident preliminary report, timing of the final radiologist report (before vs. after disposition) was not a significant multivariable predictor of inpatient admission (p = 0.63), readmission within 30 days (p = 0.66), second operation within 30 days (p = 0.09), or death (p = 0.63). Unadjusted event rates for overnight vs daytime reports, respectively, were 37.2% vs. 38.0% (inpatient admission), 15.9% vs. 16.5% (30-day readmission), 0.65% vs. 0.3% (second operation within 30 days), and 0.85% vs. 1.3% (death). CONCLUSION Given the presence of an experienced senior resident preliminary report, availability of a final radiology report prior to ED disposition did not affect four major clinical care outcomes of patients with abdominal pain undergoing abdominopelvic CT.
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Patel AG, Pizzitola VJ, Johnson CD, Zhang N, Patel MD. Radiologists Make More Errors Interpreting Off-Hours Body CT Studies during Overnight Assignments as Compared with Daytime Assignments. Radiology 2020; 297:374-379. [PMID: 32808887 DOI: 10.1148/radiol.2020201558] [Citation(s) in RCA: 25] [Impact Index Per Article: 6.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Abstract
Background There is increasing research attention on the impact of overnight work on radiologist performance. Prior studies on overnight imaging interpretive errors have focused on radiology residents, not on the relative performance of board-eligible or board-certified radiologists at night compared with during the day. Purpose To analyze the rate of clinically important interpretation errors on CT examinations of the abdomen, pelvis, or both ("body CT studies") committed by radiology fellows working off-hours based on day or night assignment. Materials and Methods Between July 2014 and June 2018, attending physicians at one tertiary care institution reviewed all body CT studies independently interpreted off-hours by radiologists in an academic fellowship within 10 hours of initial interpretation. Discrepancies affecting acute or follow-up clinical care were classified as errors. In this retrospective study, the error rate for studies interpreted during the day (between 7:00 am and 5:59 pm) was compared with that of studies interpreted at night (between 6:00 pm and 6:59 am). Error rate in the first half of day and night assignments was compared with error rate in the latter half. Statistical analyses used χ2 tests and general estimating equations; significance was defined as P < .05. Results There were 10 090 body CT studies interpreted by 32 radiologists. Forty-four of 2195 daytime studies (2.0%) had errors compared with 240 of 7895 nighttime studies (3.0%; P = .02). Twenty-two of 32 (69%) radiologists had higher error rates for night cases (P = .03). There were more errors in the last half of a night assignment (125 of 3358, 3.7%; P = .002) compared with the first half (115 of 4537, 2.5%). Conclusion On the basis of a subspecialty review, clinically important off-hours body CT interpretation errors occurred more frequently overnight and more frequently in the latter half of assignments, with more radiologists having worse error rates at night compared with the day. © RSNA, 2020 See also the editorial by Bruno in this issue.
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Affiliation(s)
- Anika G Patel
- From the Department of Radiology, Mayo Clinic Arizona, 5777 E Mayo Blvd, Phoenix, AZ 85054 (A.G.P., V.J.P., C.D.J., M.D.P.); and Department of Health Science Research, Section of Biostatistics, Mayo Clinic Arizona, Scottsdale, Ariz (N.Z.)
| | - Victor J Pizzitola
- From the Department of Radiology, Mayo Clinic Arizona, 5777 E Mayo Blvd, Phoenix, AZ 85054 (A.G.P., V.J.P., C.D.J., M.D.P.); and Department of Health Science Research, Section of Biostatistics, Mayo Clinic Arizona, Scottsdale, Ariz (N.Z.)
| | - C Daniel Johnson
- From the Department of Radiology, Mayo Clinic Arizona, 5777 E Mayo Blvd, Phoenix, AZ 85054 (A.G.P., V.J.P., C.D.J., M.D.P.); and Department of Health Science Research, Section of Biostatistics, Mayo Clinic Arizona, Scottsdale, Ariz (N.Z.)
| | - Nan Zhang
- From the Department of Radiology, Mayo Clinic Arizona, 5777 E Mayo Blvd, Phoenix, AZ 85054 (A.G.P., V.J.P., C.D.J., M.D.P.); and Department of Health Science Research, Section of Biostatistics, Mayo Clinic Arizona, Scottsdale, Ariz (N.Z.)
| | - Maitray D Patel
- From the Department of Radiology, Mayo Clinic Arizona, 5777 E Mayo Blvd, Phoenix, AZ 85054 (A.G.P., V.J.P., C.D.J., M.D.P.); and Department of Health Science Research, Section of Biostatistics, Mayo Clinic Arizona, Scottsdale, Ariz (N.Z.)
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Plotkin JB, Xu EJ, Fine DM, Knicely DH, Sperati CJ, Sozio SM. A Night Float System in Nephrology Fellowship: A Mixed Methods Evaluation. KIDNEY360 2020; 1:631-639. [PMID: 35372934 PMCID: PMC8815554 DOI: 10.34067/kid.0001572020] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/25/2020] [Accepted: 05/06/2020] [Indexed: 06/14/2023]
Abstract
BACKGROUND Johns Hopkins was an early adopter of an in-house nephrology fellowship night float to improve work-life balance. Our study aimed to elucidate attitudes to guide fellowship structuring. METHODS We performed a mixed-methods study surveying Johns Hopkins fellows, alumni, and faculty and conducting one focus group of current fellows. Surveys were developed through literature review, queried on a five-point Likert scale, and analyzed with t and ANOVA tests. The focus group transcript was analyzed by two independent reviewers. RESULTS Survey response rates were 14 (100%) fellows, 32 (91%) alumni, and 17 (94%) faculty. All groups felt quality of patient care was good to excellent with no significant differences among groups (range of means [SD], 4.1 [0.7]-4.6 [0.7]; P=0.12), although fellows had a statistically significantly more positive view than faculty on autonomy (4.6 [0.5] versus 4.1 [0.3]; P=0.006). Fellows perceived a positive effect across all domains of night float on the day team experience (range, 4.2 [0.8]-4.6 [0.6]; P<0.001 compared with neutral effect). Focus group themes included patient care, care continuity, professional development, wellness, and structural components. One fellow said, "…my bias is that every program would switch to a night float system if they could." All groups were satisfied with night float with 4.7 [0.5], 4.2 [0.8], and 4.0 [0.9] for fellows, faculty, and alumni, respectively; fellows were most enthusiastic (P=0.03). All three groups preferred night float, and fellows did so unanimously. CONCLUSIONS Night float was well liked and enhanced the perceived daytime fellow experience. Alumni and faculty were positive about night float, although less so, possibly due to concerns for adequate preparation to handle overnight calls after graduation. Night float implementation at other nephrology programs should be considered based on program resources; such changes should be assessed by similar methods.
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Affiliation(s)
- Jennifer B. Plotkin
- Department of Medicine, University of California, Los Angeles, Los Angeles, California
| | - Eric J. Xu
- Division of Nephrology, Department of Medicine, Johns Hopkins University School of Medicine, Baltimore, Maryland
| | - Derek M. Fine
- Division of Nephrology, Department of Medicine, Johns Hopkins University School of Medicine, Baltimore, Maryland
| | - Daphne H. Knicely
- Division of Nephrology, Department of Medicine, Johns Hopkins University School of Medicine, Baltimore, Maryland
| | - C. John Sperati
- Division of Nephrology, Department of Medicine, Johns Hopkins University School of Medicine, Baltimore, Maryland
| | - Stephen M. Sozio
- Division of Nephrology, Department of Medicine, Johns Hopkins University School of Medicine, Baltimore, Maryland
- Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland
- Welch Center for Prevention, Epidemiology, and Clinical Research, Johns Hopkins Medical Institutions, Baltimore, Maryland
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Matalon SA, Chikarmane SA, Yeh ED, Smith SE, Mayo-Smith WW, Giess CS. Variability in the Use of Simulation for Procedural Training in Radiology Residency: Opportunities for Improvement. Curr Probl Diagn Radiol 2019; 48:241-246. [DOI: 10.1067/j.cpradiol.2018.02.008] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/05/2018] [Revised: 02/25/2018] [Accepted: 02/26/2018] [Indexed: 11/22/2022]
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Huang J, Patel S, Scruggs R, Levin D. In Pursuit of Fellowship: Results From a 2016 Survey of US Trainees. Curr Probl Diagn Radiol 2019; 48:22-26. [DOI: 10.1067/j.cpradiol.2017.10.013] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/07/2017] [Revised: 10/29/2017] [Accepted: 10/31/2017] [Indexed: 11/22/2022]
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Bruno MA, Duncan JR, Bierhals AJ, Tappouni R. Overnight Resident versus 24-hour Attending Radiologist Coverage in Academic Medical Centers. Radiology 2018; 289:809-813. [PMID: 30277849 DOI: 10.1148/radiol.2018180690] [Citation(s) in RCA: 29] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Abstract
Academic medical centers have long relied on radiology residents to provide after-hours coverage, which means that they essentially function with autonomy. In this approach, attending radiologist review of resident interpretations occurs the following morning, often by subspecialist faculty. In recent years, however, this traditional coverage model in academic radiology departments has been challenged by an alternative model, the 24-hour attending radiologist coverage. Proponents of this new model seek to improve patient care after hours by increasing report accuracy and the speed with which the report is finalized. In this article, we review the traditional and the 24-hour attending radiologist coverage models. We summarize previous studies that indicate that resident overnight error rates are sufficiently low so that changing to an overnight attending model may not necessarily provide a meaningful increase in report accuracy. Whereas some centers completely replaced overnight residents, we note that most centers use a hybrid model, and overnight residents work alongside supervising attending radiologists, much as they do during the day. Even in this hybrid model, universal double reading and subspecialist final review, typical features of the traditional autonomous resident coverage model, are generally sacrificed. Because of this, changing from resident coverage to coverage by an attending radiologist that is 24 hours/day, 7 days/week may actually have detrimental effects to patient safety and quality of care provided. Changing to an overnight attending radiologist model may also have negative effects on the quality of radiology resident training, and it significantly increases cost.
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Affiliation(s)
- Michael A Bruno
- From the Department of Radiology, Penn State Milton S. Hershey Medical Center and Penn State College of Medicine, 500 University Dr, H-066, Hershey, PA 17033 (M.A.B.); Mallinckrodt Institute of Radiology, Washington University School of Medicine, St Louis, Mo (J.R.D., A.J.B.); and Department of Radiology, Wake Forest University Baptist Medical Center, Winston-Salem, NC (R.T.)
| | - James R Duncan
- From the Department of Radiology, Penn State Milton S. Hershey Medical Center and Penn State College of Medicine, 500 University Dr, H-066, Hershey, PA 17033 (M.A.B.); Mallinckrodt Institute of Radiology, Washington University School of Medicine, St Louis, Mo (J.R.D., A.J.B.); and Department of Radiology, Wake Forest University Baptist Medical Center, Winston-Salem, NC (R.T.)
| | - Andrew J Bierhals
- From the Department of Radiology, Penn State Milton S. Hershey Medical Center and Penn State College of Medicine, 500 University Dr, H-066, Hershey, PA 17033 (M.A.B.); Mallinckrodt Institute of Radiology, Washington University School of Medicine, St Louis, Mo (J.R.D., A.J.B.); and Department of Radiology, Wake Forest University Baptist Medical Center, Winston-Salem, NC (R.T.)
| | - Rafel Tappouni
- From the Department of Radiology, Penn State Milton S. Hershey Medical Center and Penn State College of Medicine, 500 University Dr, H-066, Hershey, PA 17033 (M.A.B.); Mallinckrodt Institute of Radiology, Washington University School of Medicine, St Louis, Mo (J.R.D., A.J.B.); and Department of Radiology, Wake Forest University Baptist Medical Center, Winston-Salem, NC (R.T.)
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Hoffmann JC, Azimov N, Chick JFB, Behbahani S, Hall G, Watts MM, Rochon PJ. The Current Status of the Interventional Radiology Fellowship Match: Results of a Resident Survey. Curr Probl Diagn Radiol 2018; 47:146-151. [DOI: 10.1067/j.cpradiol.2017.06.002] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/21/2017] [Revised: 05/29/2017] [Accepted: 06/01/2017] [Indexed: 11/22/2022]
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