Who’s Reading Emergency Pediatric Scans?

Nationwide, pediatric patients who get imaged overnight or on the weekends are more likely to have their studies read by a radiology resident or a teleradiologist than an attending physician – a practice that undermines recent efforts to improve patient access to expert providers.

In a study published May 11 in the Journal of the American College of Radiology, a multi-institutional team of investigators published survey results from academic pediatric hospitals that show few hospitals offer 24-hour in-house attending coverage.

“We identified widespread use of resident radiologists without attending radiologist supervision and teleradiology services when providing initial reports during out of hours, with 24-hour attending radiologist coverage being used at a minority of institutions,” said the team led by Robert Sutton, BM, BCh, from the University Hospital Llandough in the United Kingdom.

Although it isn’t yet clear whether these staffing variations negatively impact patient care, they do not fall in line with recent efforts that advocate for round-the-clock coverage regardless of the time of imaging.

Sutton and his team surveyed 42 radiology departments in academic pediatric hospitals by phone, focusing on their staffing models and report batching. They asked about timing, location, and radiologist experience for initial and final interpretation of emergency department imaging studies during weekdays, overnights, and weekends.

According to their analysis of information provided by administrative staff, radiology directors, attending radiologists, and residents, the team made several discoveries.

• While attending radiologists played a role in pediatric image interpretation in 100 percent of cases reviewed during the weekday hours, they were involved in only 33.3 percent and 69 percent of overnights and weekends, respectively.
• More than a quarter – 28.6 percent of hospitals surveyed employed teleradiologists for overnight rights. On the weekends, the amount was 2.4 percent.
• During overnight shifts, 38.1 percent of hospitals relied on radiology residents without attending supervision for initial interpretations for pediatric images. That number fell to 28.6 percent on the weekends.
• During weekdays, 100 percent of hospitals said they finalized radiology reports as soon as possible. However, the situation was different during overnight hours – only 52.4 percent did so. The weekends were somewhat better with 78.6 percent saying they finalized reports as quickly as possible.

“That such a sizable share of academic pediatric hospitals continue to depend on resident radiologist or outside teleradiology imaging interpretation during overnight and weekend periods is noteworthy,” the team said. “Advocates of 24-7 attending radiologist staffing typically argue…that having less-experienced resident radiologists providing reports during emergencies without senior involvement may be unsafe, and that having an attending radiologist expedites communication with colleagues in other departments and improve workflow.”

But, there are reasons why these staffing variations might exist, Sutton’s team explained. One of the key issues could be affordability – the cost of 24-hour coverage can be quite large, making teleradiology a more cost-effective and attractive option.

In addition, some pediatric hospitals may intentionally opt to forego 24-7 coverage as a training tactic for residents. Proponents, the team said, argue that the situations give residents the opportunity to make clinical judgements without immediate attending involvement – but still with the knowledge that the attending can be contacted on the most challenging cases.

Ultimately, the team said, this lack of a standard approach to staffing highlights the need to ensure that all implemented staffing models deliver comparable patient care regardless of when a pediatric patient presents to the emergency department.

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