Interruptions abound for on-call radiologists

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On-call radiologists may experience interruptions as frequently as every four minutes, according to a study published in the June issue of the Journal of the American College of Radiology.

Although it’s recognized that a link exists between frequent interruptions and patient safety, the role of interruptions in radiology has not been well studied.

“The workflow of the on-call radiologist, in particular, is especially vulnerable to disruption by telephone calls and other modes of physician-to-physician communication. On-call radiologists handle multiple responsibilities…as a result, noninterpretative responsibilities now occupy an outsized role in the workflow of on-call radiologists and, in many instances, consume far more time and effort than the actual practice of radiologic image interpretation,” wrote lead author John-Paul J. Yu, MD, PhD, of the University of California in San Francisco, and colleagues.

The researchers analyzed records from their medical center’s centralized telecommunications center, which covered the start date, time, and duration of each inbound and outbound call made between July 14, 2012 and October 12, 2012 to quantify the degree of interruption experienced by on-call radiologists and investigate potential implications in patient safety and clinical care. During the data collection period, 10,378 calls were completed during on-call hours. Of these calls, 55 percent, or 5,759, were incoming. The median length of calls was 57 seconds. During a typical 12-hour overnight on-call shift, there was an average of 72 phone calls with an average of 108 minutes spent on the phone. During an overnight shift, there was an average of 19.3 CT studies.

Analysis revealed a high correlation between hourly average CT and telephone call volumes. The probability of being interrupted at least once while reading a study increased with the length of time needed to read the study. Between 1 p.m. and 1 a.m., the probability of being interrupted at least once by an incoming phone call was 37 percent for a study that required five minutes to read. This increased to 59 percent for a ten minute study.

The researchers have implemented systems-based practice improvements to reduce the disruptive work atmosphere of on-call radiologists by leveraging a new electronic medical record, adopting use of second in-house radiology call room immediately adjacent to the physician workspace in the emergency department, and introducing residents to the call room so that they may assist the on-call radiologist by answering the phone.

“Although numerous reports have documented the effects that frequent interruptions have on physician performance, further research is needed to specifically ascertain the effects of frequent interruptions on the performance of on-call radiologists at academic institutions,” wrote Yu and colleagues.

The researchers suggest examining additional disruptive factors including the frequency of in-person consultations and sonographer and technologist interactions.