Overnight Radiology Staff in ED Cuts Recall Rate

CHICAGO — Having radiologists on duty during the overnight hours in emergency departments (ED) decreased imaging-related recalls among patients who needed acute care, a researcher reported here.

Based on ED visit information of 2 years prior (2016 and 2017) and 1 year after (2018) rollout of overnight radiology staff coverage, there were 54 radiology-related recalls during the overnight hours covered by residents in 2016, and 61 recalls in 2017, but that figure dropped to seven in 2018 when radiologists covered overnight hours (P<0.001), according to Ferco Berger, MD, of the University of Toronto/Sunnybrook Health Sciences Center.

That reduction took place despite an 8.8% increase in imaging performed in those overnight hours in 2018, he explained in a presentation at the Radiological Society of North America (RSNA) annual meeting.

Berger suggested that 69 recalls would have been made in 2018 if residents were still manning the overnight radiology, and that the odds of having an imaging-related recall were eight to nine times higher in 2016 and 2017, respectively, versus in 2018.

“The implementation of overnight in-house [ED] radiologists has significantly reduced the rate of emergency department recalls related to discrepant radiology reports at our institution, resulting in decreased costs and improved patient flow through our busy emergency and radiology departments,” he said.

RSNA session moderator Karen Lee, MD, of Beth Israel Deaconess Medical Center/Harvard Medical School in Boston, called the finding “a natural event.”

“What we had before were really preliminary reports by trainees, and so when these reports are re-evaluated in the morning, the radiologist may be picking up things that were not seen in the frenetic nature of overnight [ED] business by the residents and others not that well trained in radiology,” she told MedPage Today. “When there is a radiologist present during those overnight hours, you are getting the interpretation much sooner, so you have fewer recalls happening because the patients are still at the hospital.”

Lee suggested that “more and more tertiary and community hospitals are moving toward 24/7 coverage of imaging by radiologists. It it is a trend that is being demanded by the hospitals.” But she cautioned that possible issues with an overnight radiology service is that it “reduces the ability of residents to improve their radiological training. There is also a cost factor because it is difficult to staff those overnight hours,” she said.

Berger agreed that 24/7 radiology staffing in the ED may be a negative impact on resident training. As for the cost of recalls, he said the cost of one recall is estimated to be $2,289, so the reduction of 62 recalls would have saved the hospitals $141,918 in a year. In addition, a reduction in imaging-related recalls relieved pressure on an ED that operates at a 110% to 115% level of admission, he said.

For the study, Berger said his institution’s ED logged 9,200 ED night visits in 2016 that included imaging studies, 9,543 such visits in 2017, and 9,992 night visits in 2018. Berger and colleagues identified all patients who had overnight imaging performed during their ED visit, and who returned to the ED within 48 hours. Two scorers reviewed the recall visit notes independently to identify recalls related to discrepant imaging reports. A third scorer reviewed cases in which there was disagreement. Chart reviews were conducted if necessary.