Emergency department image interpretation services at private community hospitals

To investigate the methods used at private community hospitals for delivering emergency department (ED) image interpretation services.

The authors contacted a random national sample of 114 hospitals by telephone and administered an "ED Radiology Coverage" questionnaire. The questionnaire included queries about daytime image interpretation duties, nighttime radiology coverage arrangements, and radiologist staffing needs. Results were stratified on the basis of ED patient volumes and trauma center designation and were analyzed statistically by using multivariate and logistic regression analyses.

Representatives of 97 EDs responded to the questionnaire. Community hospital radiologists performed daytime primary interpretation of radiographs at 39 (40%) of 97 EDs, computed tomographic (CT) scans at 91 (95%) of 96 EDs, and ultrasonographic images at 87.5 (93%) of 94 EDs. "ED-dedicated" radiologists performed this emergency radiology work in only two (2%) of 97 EDs. During the nighttime, eight (8%) of 97 EDs had no radiology coverage, 80 (82%) of 97 EDs used teleradiology services in some form, and nine (9%) of 97 EDs employed in-house, rotating "non-ED-dedicated" radiologists. Analysis of participant responses revealed that clinicians at 37 (38%) of 97 EDs were able to consult radiologists for nighttime radiography questions, and 87 (92%) of 95 EDs had nighttime CT scans read by radiologists in time for patient care decisions. Twenty-four (25%) of 97 EDs reported radiologist staffing shortages, but only one indicated that it was actively trying to recruit ED-dedicated radiologists. Results of logistic regression analysis indicated that higher ED patient volumes (P =.005) and the presence of a trauma center (P =.02) each significantly increases the probability of higher nighttime levels of radiologist coverage.

There is great variation in the current provision of emergency radiology services in private community hospitals.