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Impact of an in-house emergency radiologist on report turnaround time

Published online by Cambridge University Press:  11 February 2015

Leslie Lamb ,
Paria Kashani ,
John Ryan ,
Guy Hebert ,
Adnan Sheikh ,
Rebecca Thornhill  and
Najla Fasih
Leslie Lamb*
Affiliation:
Department of Medical Imaging, The Ottawa Hospital, University of Ottawa, Ottawa, ON
Paria Kashani
Affiliation:
Department of Medical Imaging, The Ottawa Hospital, University of Ottawa, Ottawa, ON
John Ryan
Affiliation:
Department of Medical Imaging, The Ottawa Hospital, University of Ottawa, Ottawa, ON
Guy Hebert
Affiliation:
Department of Emergency Medicine, The Ottawa Hospital, University of Ottawa, Ottawa, ON
Adnan Sheikh
Affiliation:
Department of Medical Imaging, The Ottawa Hospital, University of Ottawa, Ottawa, ON
Rebecca Thornhill
Affiliation:
Department of Medical Imaging, The Ottawa Hospital, University of Ottawa, Ottawa, ON
Najla Fasih
Affiliation:
Department of Medical Imaging, The Ottawa Hospital, University of Ottawa, Ottawa, ON
*
Correspondence to: Dr. Leslie Lamb, The Ottawa Hospital, 501 Smyth Road, Ottawa, ON K1H 8L6; [email protected].

Abstract

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Background

One of the many challenges facing emergency departments (EDs) across North America is timely access to emergency radiology services. Academic institutions, which are typically also regional referral centres, frequently require cross-sectional studies to be performed 24 hours a day with expedited final reports to accelerate patient care and ED flow.

Objective

The purpose of this study was to determine if the presence of an in-house radiologist, in addition to a radiology resident dedicated to the ED, had a significant impact on report turnaround time.

Methods

Preliminary and final report turnaround times, provided by the radiology resident and staff, respectively, for patients undergoing computed tomography or ultrasonography of their abdomen/pelvis in 2008 (before the implementation of emergency radiology in-house staff service) were compared to those performed during the same time frame in 2009 and 2010 (after staffing protocols were changed).

Results

A total of 1,624 reports were reviewed. Overall, there was no statistically significant decrease in the preliminary report turnaround times between 2008 and 2009 (p = 0.1102), 2009 and 2010 (p = 0.6232), or 2008 and 2010 (p = 0.0890), although times consistently decreased from a median of 2.40 hours to 2.08 hours to 2.05 hours (2008 to 2009 to 2010). There was a statistically significant decrease in final report turnaround times between 2008 and 2009 (p < 0.0001), 2009 and 2010 (p < 0.0011), and 2008 and 2010 (p < 0.0001). Median final report times decreased from 5.00 hours to 3.08 hours to 2.75 hours in 2008, 2009, and 2010, respectively. There was also a significant decrease in the time interval between preliminary and final reports between 2008 and 2009 (p < 0.0001) and 2008 and 2010 (p < 0.0001) but no significant change between 2009 and 2010 (p = 0.4144).

Conclusion

Our results indicate that the presence of a dedicated ED radiologist significantly reduces final report turnaround time and thus may positively impact the time to ED patient disposition. Patient care is improved when attending radiologists are immediately available to read complex films, both in terms of health care outcomes and regarding the need for repeat testing. Providing emergency physicians with accurate imaging findings as rapidly as possible facilitates effective and timely management and thus optimizes patient care.

Résumé

Contexte

L’une des nombreuses difficultés auxquelles font face les services des urgences (SU) partout en Amérique du Nord est l’accés rapide aux services de radiologie d’urgence. Les établissements universitaires, qui en général servent aussi de centres régionaux spécialisés, exigent souvent que des examens en coupe transversale soient effectués 24 h sur 24, suivis de la production rapide de rapports définitifs afin d’accélérer les soins aux patients et le roulement au SU.

Objectif

L’étude avait pour but de déterminer si la présence sur place d’un radiologiste, outre celle d’un résident en radiologie en service exclusif au SU, aurait une incidence importante sur le temps de production des rapports.

Méthode

Les temps de production des rapports préliminaires et définitifs, fournis par les résidents en radiologie et par le personnel, respectivement, concernant des patients ayant subi une tomodensitométrie ou une échographie abdominales ou pelviennes en 2008 (avant la dotation en personnel sur place en radiologie d’urgence) ont été comparés avec ceux enregistrés en 2009 et en 2010 (aprés les changements apportés aux protocoles de dotation en personnel).

Résultats

Au total, 1624 rapports ont été revus. Dans l’ensemble, il n’y a pas eu de diminution statistiquement significative du temps de production des rapports préliminaires entre 2008 et 2009 (p = 0.1102), entre 2009 et 2010 (p = 0.6232) et entre 2008 et 2010 (p = 0.0890), malgré une diminution constante de ce temps de production, qui est passé d’une durée médiane de 2.40 heures á 2.08 heures, puis á 2.05 heures (2008 á 2009 á 2010). Par contre, une diminution statistiquement significative du temps de production des rapports définitifs a éte´ relevée entre 2008 et 2009 (p < 0.0001), entre 2009 et 2010 (p < 0.0011) et entre 2008 et 2010 (p < 0.0001). La durée médiane de production des rapports de´ finitifs est passée de 5.00 heures á 3.08 heures, puis á 2.75 heures en 2008, en 2009 et en 2010, respectivement. Une diminution importante de l’intervalle entre la production des rapports préliminaires et celle des rapports définitifs a également été observée entre 2008 et 2009 (p < 0.0001) et entre 2008 et 2010 (p < 0.0001), mais aucun changement important n’a éte´ relevé entre 2009 et 2010 (p = 0.4144).

Conclusions

Les résultats de l’étude indiquent que la présence d’un radiologiste en service exclusif au SU réduit de fac¸on sensible le temps de production des rapports définitifs et, de ce fait, peut se répercuter favorablement sur le temps écoulé avant de connaître les suites á donner aux patients au SU. La présence de radiologistes traitants, prêts á interpré ter immédiatement des images compliquées se traduit par une amélioration des soins aux patients, en ce qui concerne tant les résultats cliniques que la nécessité d’autres examens. Le fait de présenter le plus rapidement possible aux urgentologues des résultats exacts d’examens par imagerie facilite une prise en charge prompte et efficace, et permet ainsi une optimisation des soins aux patients.

Keywords

emergency radiologyradiology servicesreport turnaround
Type
Original Research
Information
Canadian Journal of Emergency Medicine , Volume 17 , Issue 1 , January 2015 , pp. 21 - 26
Copyright
Copyright © Canadian Association of Emergency Physicians 2014 

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