Workload fatigue is harming radiology residents’ reporting, declining as the hours, days elapse

Diagnostic imaging utilization has increased dramatically over the past few decades, burdening radiologists with heavier workloads and higher burnout rates. This effect has trickled down to residents, as fatigue decreases the quality of their reporting throughout the workday and week.

From 1999 to 2010, CT use increased by 1,300% while MRI saw a 540% spike. And while most radiology departments have staffed up to combat rising workloads, many providers have been left with a sevenfold increase in responsibilities. Fatigue and medical errors are known to follow closely behind, researchers explained Tuesday in Radiology.

A team of Swiss radiologists analyzed more than 117,000 reports written by residents and found that as the hours and days piled up, such documents required more changes before being finalized. These discrepancies underscore the damaging effects of fatigue on radiologists and, potentially, patient care.

“The constant increase in workloads in radiology departments has rendered radiologist fatigue, and its effects on diagnostic accuracy, a rising topic,” Jan Vosshenrich, MD, and colleagues with University Hospital Basel’s Department of Radiology, wrote in the study. “Decreases in report similarity over the course of workdays and workweeks suggest aggravating effects of fatigue on residents’ report-writing performance,” they went on to say.

To arrive at their conclusions, Vosshenrich et al. extracted data from 117,402 radiology reports composed by residents at their institution between September 2017 and March 2020. By comparing residents’ preliminary reports and staff-reviewed final documents, the authors ranked the number of edits performed during proofreading on a scale of 0 to 1, the latter reflecting no edits and perfect similarity.

Overall, reports became less similar (more required editing) as residents’ day and weekend shifts elapsed. This was particularly true on Fridays, where reporting differences were highest and included a 16% lower similarity at 5 p.m. compared with 8 p.m. And for later shifts, report similarity continually decreased from Monday to Friday.

Importantly, the authors found similarities temporarily rebounded after lunch breaks (30-minute and 45-minute) for both day and weekend shifts, and when a rested resident took over during overlapping on-call shifts. 

“Reproducible increases in report similarity after lunch breaks are consistent with previous investigations, suggesting that regular breaks may optimize reader performance and reduce eye strain, which occurs as a symptom of visual fatigue,” the authors explained.

Another approach to limiting fatigue may be to cap radiologists’ workloads and obligations, as one American College of Radiology expert recently advocated. In fact, Frank J. Lexa, MD, MBA, chief medical officer of the ACR’s Radiology Leadership Institute, said to help enhance both patient and provider safety, shift lengths should not exceed 10 hours.

Going forward, Vosshenrich et al. urged radiology departments to begin considering regular break periods.

“In conclusion, we demonstrated that report comparison can reveal and quantify trends in report similarity,” they added. “Decreases in report similarity over the course of workdays and workweeks suggest aggravating effects of fatigue on residents’ report-writing performance. Periodic breaks within shifts potentially foster recovery.”