Resident Performance Benefits from 24/7 Attending Coverage

Radiology residency programs that have shifted to a learning model that includes 24/7 in-house radiology attending coverage are seeing positive results in terms of resident performance, efficiency and patient care, new research shows.

By Felicia Dechter

As with all academic medical centers, our radiology residency program has experienced the transition towards more direct supervision with an on-site radiology attending presence," said Siavash Behbahani, MD, MS, a third-year radiology resident at Winthrop-University Hospital in Mineola, N.Y., during a Sunday session. "While multiple economic and legal forces have fueled this movement, it challenges traditional learning models for radiology residents."

In assessing the impact of 24/7 in-house radiology attending coverage on radiology resident performance at Winthrop, Dr. Behbahani and principal project investigator, A. Orlando Ortiz, MD, MBA, chairman of the Radiology Residency Program at Winthrop, retrospectively reviewed radiology resident reports on emergent diagnostic radiology procedures conducted between November 2015 and March 2016.

In all, 29,636 studies were preliminarily interpreted by 17 radiology residents on call under 24/7 supervision by an in-house radiology attending who was available for questions during the shift.

The analysis demonstrated that the resident-faculty rate of missed findings for radiographs was 0.8 percent compared to a higher rate reported in the literature of 1.4 percent without 24/7 direct attending supervision, Dr. Behbahani said.

Results also demonstrated a decrease in the rate of resident-faculty discrepancy for cross-sectional studies (CT — 0.5 percent vs. 2.4 percent, ultrasound — 0.1 percent vs. 0.6 percent, and MR — 1.1 percent vs. 3.7 percent). The first number relates to residents under 24/7 direct attending supervision, while the second — the versus number — relates to independent resident calls in his study, Dr. Behbahani said.

As the year of resident training increased, missed findings decreased, he said.

"We also observed that the rates of minor and major discrepancies substantially decreased with increasing resident year of training," Dr. Behbahani said. "Finally, the turn-around time for generating radiology resident preliminary reports decreased as compared to turn-around times previously reported in the literature."

Ultimately, results demonstrated that radiology resident on-call performance — with respect to diagnostic radiology interpretations — improves with the presence of 24/7 in-house radiology attending coverage.

And in-house radiology attending coverage and supervision ultimately improves patient care, emergency room management/discharge time and appropriateness of management, researchers said.

Communication Key to Reducing Miss Rates

Missed radiologic findings are not uncommon in general, Dr. Behbahani said. A plethora of studies — including research on single radiologist interpretations — have shown miss rates as high as 19 percent, he said.

"There is also literature which suggests that the studies that are preliminarily interpreted by radiology residents and subsequently reviewed and interpreted by an attending radiologist have shown lower rates of missed findings compared to that of an attending interpretation alone," Dr. Behbahani said.

Keeping the rate of missed findings as low as possible benefits radiology on a number of fronts — from economics to patient care to the quality of resident education, Dr. Behbahani said.

"At the critical level of resident education, this 24/7 in-house attending approach reinforces communication as a key driver in enhancing the call experience as a true learning platform," he said.

Along with adopting the 24/7 attending supervision model, Dr. Behbahani suggests that institutions embrace strategies that optimize the interpretation experience and environment. This approach could range from using standardized imaging protocols and search patterns to adopting reading stations that offer optimal lighting, proper ergonomic conditions and controlled interruptions.

"The intrinsic value of this coverage model is founded on the concept of multidirectional proactive communication," Dr. Behbahani said.