UCLA, Department of Radiology, Neuroradiology and Acute Care Imaging Sections, Los Angeles, CA.
UCLA, Department of Radiology, Neuroradiology and Acute Care Imaging Sections, Los Angeles, CA.
Curr Probl Diagn Radiol. 2020 May-Jun;49(3):168-172. doi: 10.1067/j.cpradiol.2018.09.004. Epub 2018 Oct 9.
To quantitatively and qualitatively assess the impact of attending neuroradiology coverage on radiology resident perceptions of the on-call experience, referring physician satisfaction, and final report turnaround times.
24/7/365 attending neuroradiologist coverage began in October 2016 at our institution. In March 2017, an online survey of referring physicians, (emergency medicine, neurosurgery, and stroke neurology) and radiology residents was administered at a large academic medical center. Referring physicians were queried regarding their perceptions of patient care, report accuracy, timeliness, and availability of attending radiologists before and after the implementation of overnight neuroradiology coverage. Radiology residents were asked about their level of independence, workload, and education while on-call. Turnaround time (TAT) was measured over a 5-month period before and after the implementation of overnight neuroradiology coverage.
A total of 28 of 64 referring physicians surveyed responded, for a response rate of 67%. Specifically, 19 of 23 second (junior resident on-call) and third year radiology residents (senior resident on-call) replied, 4 of 4 stroke neurology fellows replied, 8 of 21 neurosurgery residents, and 16 of 39 emergency medicine residents replied. Ninety-five percent of radiology residents stated they had adequate independence on call, 100% felt they have enough faculty support while on call, and 84% reported that overnight attending coverage has improved the educational value of their on-call experience. Residents who were present both before and after the implementation of TAT metrics thought their education, and independence had been positively affected. After overnight neuroradiology coverage, 85% of emergency physicians perceived improved accuracy of reports, 69% noted improved timeliness, and 77% found that attending radiologists were more accessible for consultation. The surveyed stroke neurology fellows and neurosurgery residents reported positive perception of the TAT, report quality, and availability of accessibility of attending radiologist.
In concordance with prior results, overnight attending coverage significantly reduced turnaround time. As expected, referring physicians report increased satisfaction with overnight attending coverage, particularly with respect to patient care and report accuracy. In contrast to some prior studies, radiology residents reported both improved educational value of the on-call shifts and preserved independence. This may be due to the tasking the overnight neuroradiology attending with dual goals of optimized TAT, and trainee growth. Unique implementation including subspecialty trained attendings may facilitate radiology resident independence and educational experience with improved finalized report turnaround.
定量和定性评估参加神经放射学覆盖对放射科住院医师对随叫随到体验的看法、主治医生满意度和最终报告周转时间的影响。
2016 年 10 月，我们医院开始提供每周 7 天、每天 24 小时、全年无休的神经放射科主治医生覆盖。2017 年 3 月，在一家大型学术医疗中心对主治医生（急诊医学、神经外科和卒中神经科）和放射科住院医师进行了在线调查。在实施夜间神经放射学覆盖前后，主治医生被询问了他们对患者护理、报告准确性、及时性以及主治放射科医生可用性的看法。放射科住院医师被问到他们在随叫随到期间的独立性、工作量和教育程度。在实施夜间神经放射学覆盖前后的 5 个月期间测量了周转时间（TAT）。
共有 64 名主治医生中的 28 名做出了回应，回应率为 67%。具体来说，23 名第二年（初级住院医师随叫随到）和第三年（高级住院医师随叫随到）放射科住院医师中有 19 名做出了回应，4 名卒中神经科研究员做出了回应，21 名神经外科住院医师中有 8 名，39 名急诊医学住院医师中有 16 名做出了回应。95%的放射科住院医师表示他们在随叫随到时有足够的独立性，100%的人表示在随叫随到时有足够的师资支持，84%的人表示夜间主治医生的覆盖提高了他们随叫随到的教育价值。在实施 TAT 指标前后都在场的住院医师认为他们的教育和独立性受到了积极的影响。在实施夜间神经放射学覆盖后，85%的急诊医师认为报告的准确性有所提高，69%的人认为及时性有所提高，77%的人认为主治放射科医生更容易进行咨询。接受调查的卒中神经科研究员和神经外科住院医师对 TAT、报告质量和主治放射科医生的可用性的看法均为正面。
与先前的结果一致，夜间主治医生的覆盖显著缩短了周转时间。不出所料，主治医生报告说，他们对夜间主治医生的覆盖更加满意，尤其是在患者护理和报告准确性方面。与一些先前的研究不同，放射科住院医师报告说，随叫随到的轮班的教育价值和独立性都有所提高。这可能是因为夜间神经放射学主治医生的任务是优化 TAT 和培训生的成长。包括专科培训主治医生在内的独特实施可能有助于放射科住院医师的独立性和教育体验，同时缩短最终报告的周转时间。
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