Hospitals ponder residents’ role in night call sonography

March 24, 2006

Findings of a Stanford University survey suggest teaching hospitals should reinforce training for radiology residents if they are to perform after-hours ultrasound scanning. Using residents to make up for the shortage of qualified sonographers could undermine medical education and compromise patient care. Data were published in the February issue of Academic Radiology.

Findings of a Stanford University survey suggest teaching hospitals should reinforce training for radiology residents if they are to perform after-hours ultrasound scanning. Using residents to make up for the shortage of qualified sonographers could undermine medical education and compromise patient care. Data were published in the February issue of Academic Radiology.

Stanford radiologists found that many institutions try various staffing alternatives to provide after-hours ultrasound scanning. Using residents is one. The study could not explain how these institutions choose or implement their graveyard shift staffing.

Clinical demand for ultrasound studies after hours is increasing, and hospitals must juggle staffing to meet that demand. Sometimes sonographers work an in-house shift and perform the scans. Sometimes they take call from home. In many cases, however, sonographers are not available, and radiology residents must perform the scans, said principal investigator Dr. Terry Desser, director of the Stanford School of Medicine's radiology residency program.

Finding sonographers willing to work night shift has become a challenge. But using residents to fill in the gap could undermine their education and, ultimately, affect patient care. Teaching hospitals should carefully balance their clinical needs against their educational duties when asking radiology residents to perform after-hours ultrasound scanning, Desser said.

"If residents are expected to perform the scans, there should be adequate training programs in place to ensure that patient care is not compromised. Documenting the nature and extent of this training is important," she said.

Desser and colleagues sought to determine who performs most after-hour sonograms at teaching hospitals. They sent a link to a two-part Web-based survey by e-mail to 405 members of the Association of Program Directors in Radiology. Part one asked who performed after-hours ultrasound scanning at the institution. Part two asked respondents to characterize their residency programs in terms of type (university or university-affiliated hospital, community, or military), size, location, and type of coverage provided.

Seventy-nine radiology programs responded:

  • 41% of respondents provided coverage with on-call sonographers

  • 30% had in-house sonographers

  • 16% combined radiology residents and sonographers to provide coverage

  • 13% provided coverage with residents alone

Differences in geographic location, type of program, or number of residents available to scan in each program do not easily explain why residents do the scans in some hospitals while sonographers do them in others. Statistical analysis did not show a significant association between location and staffing.

"Our study survey was very simple and did not allow us to find out what types of scans were being done," Desser said. "We can't say whether technologists are used for 'more complicated' cases and residents for more simple cases."

As the U.S. population ages, the overall number of imaging procedures increases, and the number of qualified sonographers drops, hospital administrators and radiologists will need creative long-term strategies to meet the demand for ultrasound services beyond expecting residents to fill in the gap, the researchers said.

Resident on-call duties must always be a balance between educational experience and provision of clinical service. Training programs must be certain that the scanning done by the resident is of educational value and not just an expedient solution to a labor shortage or other business factor, Desser said.

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