Department of Radiology, University of Pittsburgh School of Medicine, Pittsburgh, PA 15213-2583, USA.
AJR Am J Roentgenol. 2012 Sep;199(3):623-6. doi: 10.2214/AJR.11.8377.
The purpose of this study is to describe a new practice model (overnight subspecialty radiology coverage) and to determine its impact on CT utilization rates in academic and community emergency departments.
Overnight subspecialty (neuroradiology and abdominal imaging) attending coverage was instituted at the University of Pittsburgh Medical Center in 2008. Previously, preliminary interpretations of CT studies performed at four academic emergency departments were provided by radiology residents. Interpretations were provided to five community emergency departments by either a senior resident or a contracted teleradiology service. Rotating shifts of neuroradiologists and abdominal imagers have since provided contemporaneous final reports for emergency department CT studies from 5:00 pm to 7:00 am. We compared total CT volume, emergency department visits, and CT "intensity" (CT volume / emergency department visits) within academic and community hospitals 12 months before and after institution of overnight coverage. We also compared on-call (5:00 pm to 7:00 am) and daytime CT intensity in academic and community emergency departments during these time periods.
Academic emergency department visits increased 7% and community emergency department visits decreased 3% during the study period. Total academic emergency department CT volume increased 8%, and community emergency department CT volume increased 9%. Daytime community emergency department CT volume remained constant, but on-call CT volume increased 16%. Academic emergency department CT intensity remained constant at 0.57, whereas community emergency department CT intensity increased from 0.40 to 0.45 (12.5%).
Institution of overnight subspecialty emergency department coverage resulted in a disproportionate increase in CT utilization in community emergency departments. We hypothesize that community emergency departments lacking in-house clinical subspecialists may be more apt to use subspecialist radiology interpretations for patient management. Overnight subspecialty coverage increases CT utilization in the community emergency department, but the appropriateness and clinical impact is uncertain and in need of exploration.
本研究旨在描述一种新的实践模式（夜间专科放射学覆盖），并确定其对学术和社区急诊部门 CT 使用量的影响。
2008 年，匹兹堡大学医学中心开始提供夜间专科（神经放射学和腹部影像学）主治医生覆盖。在此之前，由放射科住院医师提供在四个学术急诊部门进行的 CT 研究的初步解读。由高级住院医师或合同远程放射服务提供给五个社区急诊部门的解读。自那时以来，神经放射学家和腹部成像师的轮班人员提供了下午 5 点至上午 7 点期间来自急诊部门 CT 研究的同期最终报告。我们比较了在实施夜间覆盖前后 12 个月内学术和社区医院的总 CT 量、急诊就诊量和 CT“强度”（CT 量/急诊就诊量）。我们还比较了这些时间段内学术和社区急诊部门夜间（下午 5 点至上午 7 点）和日间 CT 强度。
在研究期间，学术急诊就诊量增加了 7%，社区急诊就诊量减少了 3%。学术急诊部门 CT 总量增加了 8%，社区急诊部门 CT 总量增加了 9%。日间社区急诊部门 CT 量保持不变，但夜间 CT 量增加了 16%。学术急诊部门 CT 强度保持在 0.57，而社区急诊部门 CT 强度从 0.40 增加到 0.45（增加了 12.5%）。
实施夜间专科急诊部门覆盖导致社区急诊部门 CT 使用量不成比例增加。我们假设，缺乏内部临床专科医生的社区急诊部门可能更倾向于将专科放射学解读用于患者管理。夜间专科覆盖增加了社区急诊部门的 CT 使用量，但适当性和临床影响尚不确定，需要进一步探讨。
