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Published on: January 18, 2018
Radiologist, Trainee, and Logistical Factors Impacting the Timeliness of CTA Head and Neck Reporting in Stroke Code
Omar A Zaree1, Jeffers K Nguyen2, Irene Dixe de Oliveira Santo2
1From the Tu Lab for Diagnostic Research (O.A.Z., A.E.K., S.R., L.H.T.), Yale School of Medicine, New Haven, Connecticut.
Insights
Timely reporting of CT angiography (CTA) for stroke codes varies significantly by radiologist. Workflow efficiency interventions for radiologists and trainees can improve stroke CTA reporting times.
Area of Science:
- Radiology
- Medical Imaging
- Neurology
Background:
- Timely reporting of CT angiography (CTA) is critical for managing acute vascular and non-vascular pathologies.
- Stroke code activations necessitate rapid interpretation of CTA exams for effective patient management.
Purpose of the Study:
- To identify modifiable factors influencing the turnaround time (TAT) of CTA reporting in stroke code activations.
- To analyze the impact of radiologist and trainee characteristics on CTA reporting timeliness.
Main Methods:
- An observational study analyzed 8422 stroke code CTA head and neck exams over four years.
- Factors examined included patient demographics, care setting, time of day, radiologist/trainee variables, and report type.
- Statistical analyses included descriptive statistics, univariate, and multivariate regression.
Main Results:
- Median TAT for stroke code CTAs was 29 minutes, with significant variation among individual attending radiologists.
- Attending radiologist and trainee performance, solo attending reporting, and preliminary reports were key factors affecting TAT.
- Increased workload (CTAs within the preceding hour) had a minimal impact on TAT.
Conclusions:
- Wide variations in stroke CTA reporting timeliness exist between radiologists and trainees.
- Targeted interventions to enhance workflow efficiency for both attending radiologists and trainees are recommended to improve reporting TAT.
Background And Purpose:
Timely reporting of CTA examinations impacts management of acute vascular pathology such as large vessel occlusions, arterial dissection, and ruptured aneurysms, as well as a variety of acute nonvascular pathologies. In this study, we examine potential modifiable factors impacting the timeliness of CTA reporting performed in stroke code activations.
Materials And Methods:
This is an observational study of stroke code CTA head and neck examinations performed at a single health system (3 emergency departments, 1550 inpatient beds) during 4 years (January 1, 2019, to December 31, 2023). Patient age, patient sex, care setting, time of year, shift type, trainee/attending radiologist characteristics, report factors, and number of CTAs performed within the preceding hour were considered potential factors impacting the turnaround time (TAT) of stroke code CTAs. Descriptive statistics, univariate regression, and multivariate regression were used to estimate the impact on reporting TAT.
Results:
We performed 8422 stroke code CTA examinations. Median TAT was 29 minutes (interquartile range [IQR] 18-48). Median TAT by individual attending radiologists varied from 15 to 40 minutes (median of medians, 29 minutes [IQR 26-34.5]). Univariate regression analyses found younger patient age, emergency department setting, time later in the academic year, nonbusiness hours, specific individual radiologists/trainees, solo reporting by attending radiologists, use of preliminary reports, and fewer stroke codes within the preceding hour to all be associated with shorter TATs (all P < .05). After adjusting for patient-, logistical-, and radiologist-level factors in a multivariate regression model, the greatest impact on TAT was seen with variation in individual attending radiologists (adjusted coefficients, -11.9 to +29.4 minutes) and trainees (-40.1 to +95.7 minutes); reporting CTAs without a trainee and release of preliminary reports before final sign were associated with faster TATs (-19.9 and -26.9 minutes, respectively). Each stroke CTA within the preceding hour was associated with only a 2.8-minute increase in TAT. Secondary analyses suggested that previewing of cases during active scanning and use of "structured" reports correlate with a favorable impact on TAT among attending radiologists (both P < .05).
Conclusions:
Radiologist and trainee-level timeliness in stroke CTA reporting varies widely. Interventions aimed at improving workflow efficiency for both trainees and attending radiologists could improve timeliness of reporting.
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