In our July 1, 2014 Patient Safety Tip of the Week “Interruptions and Radiologists” we took a look at the impact of interruptions and distractions on the workflow of radiologists. A study (Yu 2014) found that during a typical 8PM to 8AM overnight shift there was an average of 72 telephone calls, with a median call duration 57 seconds, and the average time spent on the phone was 108 minutes. The median interval from the start of one telephone call to the start of the next ranged from 3 to 10 minutes, depending on the time of day. There was also a correlation between volume of phone calls and the volume of CT scans being done (volume of other imaging studies was not measured as part of this study). That study did not include any measure of image interpretation accuracy or disparities between interpretations by the on-call radiologist and any subsequent interpretations.
But now another study has looked at the impact of telephone calls on radiology residents on-call to determine whether there was a relationship between these and discrepancies on reports (Balint 2014). While there was a only a slight difference in total phone calls per shift between those shifts with and without report discrepancies, there was a statistically significant increase in the average number of phone calls in the 1 hour preceding the generation of a discrepant preliminary report (4.23 vs. 3.24 calls). The authors suggest that one additional phone call during the hour preceding the generation of a discrepant preliminary report resulted in a 12% increased likelihood of a resident error.
One of the strategies they recommend to prevent such interruptions is to have other staff handle phone calls. Additonal potential strategies include interruption-free zones and having a separate radiologist or radiology resident handle consultations. The previous study by Yu and colleagues noted that posting preliminary reports on the electronic medical record has likely had a beneficial effect on frequency of calls. They, too, have also begun having medical students assist the on-call radiologist by answering the phone and triaging imaging reports. We added that radiology physician assistants can help with things like contrast injections, etc. during high activity periods that might also interrupt radiologists’ reading. Hospitals having the luxury of larger radiology staffs might have a dedicated second radiologist during high volume periods whose sole responsibility is interpreting images. Note that the latter might also be reading images off-site via teleradiology.
We also stressed that much time can be wasted in tracking down the appropriate physician when communicating significant findings. So anything you can do to facilitate identification of the responsible physician would be a positive step.
Prior Patient Safety Tips of the Week dealing with interruptions and distractions:
Yu J-P, Kansagra AP, Morgan J. The Radiologist's Workflow Environment: Evaluation of Disruptors and Potential Implications. JACR 2014; published online April 26, 2014
Balint BJ, Steenburg SD, Lin H, et al. Do Telephone Call Interruptions Have an Impact on Radiology Resident Diagnostic Accuracy? Academic Radiology 2014; published online September 30, 2014
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