Radiology Services in Emergency Medicine Residency Programs: A National Survey

Abstract

Objectives: To determine who reads plain film radiographs, how quickly radiologists' interpretations are available, how many initial readings require correction, and how satisfied emergency physicians (EPs) are with radiology in emergency departments (EDs) with emergency medicine (EM) residency programs. Methods: A questionnaire was sent to the chairs of all U.S. EM residencies, asking about EM radiology services. Results: Of 120 sites surveyed, 97 (81%) responded. Respondents reported that, on weekday days, EM attendings or residents performed the radiograph interpretation used for clinical decision making at 66% of sites; on nights and weekends, EPs performed the clinically relevant readings at 79% of sites. Twenty-one percent of sites reported that no radiologist reviewed images before patients left the ED on nights and weekends. Only 39% of sites reported that all images were read within four hours on weekday days, and only 19% of sites reported readings within this time frame on nights and weekends. Median misinterpretation rates were reported as 1% on weekday days and 1.5% at other times. Overall, EPs were satisfied with their interactions with radiology at 63% of EDs. Conclusions: This study summarizes the perceptions of EPs regarding radiology services; the findings must be interpreted with caution, given the lack of external validation. Nevertheless, EPs report that many EM residency programs depend on EPs' interpretations of radiographs. Emergency physicians report that attending radiologists rarely read images on nights and weekends and that images are misread more frequently at these times. Although EPs were satisfied with many aspects of radiology, EPs expressed the most dissatisfaction with turnaround times and misreads. Key words: radiology; radiographs; x-rays; emergency medicine; residency. ACADEMIC EMERGENCY MEDICINE 2002; 9:587-594. Although many patients treated in the emergency department (ED) are managed solely by emergency physicians (EPs), a substantial number of patients require consultation with other specialists. At best, these consultations lead to good clinical outcomes, aided by ready availability of specialists and good communication among physician colleagues. At worst, consultations may lead to delays and poor communication, resulting in dissatisfied patients, frustrated clinicians, and increased potential for medical errors. Optimizing the relationship between EPs and consultants may be particularly challenging in teaching hospitals, where residents serving as consultants may function with varying degrees of supervision by their attendings.In many EDs, radiologists are probably the most commonly consulted physicians. A large proportion of ED patients receive radiographs, and in many EDs all radiographs are interpreted by radiologists. Therefore, the relationship between emergency medicine (EM) and radiology may have a substantial impact on patient flow and quality of care in EDs. Although the relationship between EM and radiology at individual institutions has been st...

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