Audit of demand for after‐hours CT scanning services in RANZCR‐accredited training departments

Abstract

Introduction: The aims of this study were to measure: (i) the growth in after-hours emergency department -referred CT (ED-CT) performed in accredited training departments between 2011 and 2013; (ii) the growth in ED CT relative to growth in ED presentations at the same hospitals; and (iii) trainee workload resulting from after-hours ED CT. Methods: Ethics approval was obtained for all participating sites. Accredited training facilities in Australia and New Zealand with three or more trainees and serving one or more EDs were invited to participate (N = 32). Four nights were surveyed between August and December 2013. For data collection, the number of ED patients having one or more CT scans; ED CT scan total images; non-contrast head CTs; and ED patients (total and categories 1 and 2) attending the ED in the preceding 24 h and first half of calendar year were collected for 2013 and corresponding days in 2012 and 2011. Trainee staffing levels were measured. Results: Eleven of 32 sites provided data for all four nights and 14 of 32 for one or more nights. A 15.7% increase in number of ED CTs between 1700 and 2200 h and 16.8% increase between 2201 and 0730 h occurred in the 2 years between 2011 and 2013 compared with a 6.9% increase in overall ED and 26% increase in categories 1 and 2 presentations over the same period. The number of CT images, however, increased 23%. Conclusion: Growth in demand by EDs for after-hours CT services has implications for service provision and trainee workloads in Royal Australian and New Zealand College of Radiologists-accredited training departments.

Clinical decision rule for non‐traumatic computed tomography of the brain

“…CTB is an essential diagnostic tool for assessing patients with potential NTBI. However, there is a lack of a well validated CDR in place to aid in ruling out low‐risk patients for this imaging modality . In our study, only 6.6% of all included scans ( n = 10 394) reported significant clinical findings.…”

“…This suggested that an over‐referral pattern exists for CTB in Australian EDs. A 2017 study by Goergen et al found Australian and New Zealand EDs had increased their demand for after‐hours CTB between 2011 and 2013, with a 15.7% increase between 17.00 hours and 22.00 hours and a 16.8% increase between 22.01 hours and 07.30 hours of the EDs surveyed. Goergen et al commented that this has effects not only on ED length of stay and monetary expenditure but also on the workload of radiology staff, making this issue a multidisciplinary challenge.…”

Trauma radiology: The need for a teaching trauma case series

“…Outside of normal working hours, a single radiology registrar is usually responsible for reporting all after hours CTs [1]. It can be several hours before a consultant radiologist reviews the CTs and thus it is the interpretation of the CT by the registrar that drives the initial management.…”

“…In many public hospitals a single radiology trainee is responsible for reporting all after hours CTs and a recent study of accredited training facilities in Australia and New Zealand showed a 16.2% increase in the number of 'out of hours' ED CTs performed between 2011 and 2013 [1]. Some hospitals are also opting to utilise teleradiology companies to report after-hours studies.…”

Optimising after-hours workflow of computed tomography orders in the emergency department

“…6 Not surprisingly, increased utilisation has resulted in increased radiology resident workload. 7 At our institution, CT scans ordered from the ED afterhours previously required a direct conversation between the radiology resident and ED staff prior to being protocolled. In our experience, this is the case in many academic institutions without a dedicated Emergency Radiology department.…”