Handling of outside trauma studies: a survey of program directors

Many trauma transfer patients arrive after hours with imaging studies performed at the transferring institution. Little attention has been given to the impact on on-call radiology residents and the potential medicolegal consequences. The purpose of this study was to assess the impact of outside trauma studies on on-call radiology residents.

A 20-question survey using the Web site www.surveymonkey.com was created to focus on the handling of outside images on trauma transfers. An institutional review board exemption for consent was obtained. The survey was distributed to all radiology residency program directors throughout the United States.

Sixty-four program directors responded to our survey. Eighty percent of program directors worked at Level 1 trauma centers, 94% of program directors were located in medium to large cities and had an average of 27 residents (range 8-74), and 69% of programs reported receiving between 1 and 5 outside trauma studies per day, most without radiologic reports from the transferring hospital. After hours (defined by periods of time when no attending staff is present), these studies are read only by radiology residents at 45% of institutions. Written documentation by residents is often lacking when they are the sole radiology interpreters, and in many of these cases, the only documentation of the interpretation is a note in the patient's chart written by the referring clinician. The issue of transfer study interpretation was deemed a "definite" issue in 45% of programs, with 78% of program directors having been approached at least once regarding this issue.

Trauma patients are usually transferred to accepting teaching institutions without written radiologic reports, which generally do not meet either American College of Radiology or American Cancer Society guidelines. Approximately half of trauma transfer patients are managed solely on the basis of radiology resident interpretation, exposing residents to medicolegal liability. There is no consensus among programs regarding the optimal handling of these studies. This issue is in critical need of attention from the radiology community to enhance timeliness of communication and patient safety, and to protect radiology residents.