24-hour staff interpretation of ED studies expanding at academic centers, still far from 100%

While after-hours radiology staff coverage in U.S. academic emergency departments (EDs) is expanding, nearly three-quarters of programs still exclusively use preliminary interpretation for some overnight hours, according to a survey of program directors of neuroradiology fellowship programs.

The survey, results of which were published in the July issue of the Journal of the American College of Radiology, also found that subspecialty 24-hour staff coverage of ED studies was very rare, at only 3 percent of programs.

“Despite the widespread use of preliminary interpretations, there is significant pressure for academic centers to provide 24-hour staff coverage with final interpretations immediately available to the emergency department clinical staff,” wrote Andrew Sellers, MD, of the University of Virginia in Charlottesville, and colleagues. “These demands are being met by different programs in a multitude of ways, but most commonly by the extension of subspecialty imaging coverage into the early evening hours with additional, primarily general radiology staff coverage for later evening hours.”

A total of 67 separate institutional responses were obtained from 96 institutions who received the web-based survey. Results showed 73 percent of programs provided only preliminary interpretations for at least some overnight hours.

Of those institutions that did provide around-the-clock staff coverage, 72 percent did so with dedicated ED sections, according to Sellers and colleagues.

Just two of the surveyed programs offered 24-hour subspecialty staff coverage.

Sellers and colleagues noted that the results are a continuation of a trend from previous studies conducted in the 2000s, which have shown increasing use of 24-hour general staff coverage for ED interpretations. ED and hospital administers were noted as the most frequent drivers of coverage changes in the current study.

Regardless of the overall trend in after-hours coverage, Sellers and colleagues emphasized the fact that only very large programs have the resources to offer 24-hour subspecialty coverage. “This finding begs the question of whether the general trend of expanding after-hours coverage will continue in the current and projected environment of decreasing reimbursement and remuneration and, if so, what effect this will have on departmental financial health.”