Mandatory turnaround times reduce resident involvement in ED imaging

The implementation of turnaround time requirements for imaging reports in emergency departments (EDs) significantly reduces the involvement of radiology residents in the reporting process and may negatively impact their professional training and education, according to study results published in the May issue of Academic Radiology.

The training regimen for residents in radiology departments has undergone extensive changes in recent years, with the focus shifting away from oral examinations toward computer-based testing of technical acumen and knowledge of diagnostic imaging. But the evolution of radiological education has also been influenced by the industry’s desire to reduce turnaround times with regard to reporting within ED settings, according to lead author Eric England, MD, of the University of Cincinnati Medical Center, and his colleagues. “Another pressure now challenges academic radiologists further with a new variable to which they must adapt: the implementation of required reduced radiology report turnaround times, potentially taking away from time spent in instruction of residents,” they wrote.

England and colleagues set out to evaluate whether or not required turnaround times for imaging reports would decrease resident involvement and negatively impact overall resident satisfaction with educational opportunities. To do so, they tracked study volume for residents in the ED for three years prior and one year following implementation of a one-hour required reporting turnaround and recorded and compared changes to resident workload among different radiology divisions as well as different work-shifts. An online survey was also sent to residents and faculty at two medical facilities with required report turnaround times to better assess the effects of the requirements on resident education.

Their results showed that resident involvement decreased significantly in ED studies of musculoskeletal, chest and neuro imaging reports, with average resident involvement dropping from 89 percent, 88 percent and 82 percent, respectively, to 66 percent, 68 percent, and 51 percent following implementation of the mandatory one-hour turnaround time. “Residents who were present both before and after the implementation of a required [turnaround times] felt their education had been significantly negatively affected,” wrote England et al. “Faculty surveyed thought that the required [turnaround time] negatively affected their ability to teach and decreased the quality of resident education.”

The researchers believe the findings show a distinct downside to turnaround time requirements for radiology reporting, despite the perceived benefits of expedited information and patient care. “A required [reporting turnaround time] places another strain on the clinical productivity of academic radiologists that is resulting in decreased resident ED study involvement” the authors concluded. “This raises the questions of whether decreased resident ED study involvement is negatively affecting resident education or just reducing resident support of activities, with more of the burden falling on the radiology attendings.”