Impact of Adding an "Early Riser Resident" on Overnight Radiology Resident Study Discrepancy Rates

Participation in overnight shifts is an invaluable experience for radiology residents. Our institution offers indirect attending supervision overnight; residents provide preliminary interpretations before final attending review the next morning. Clinically significant misses are labeled with a "Flag M" designation during attending review. Our program added an "Early Riser Resident" (ERR) who overlaps with overnight residents in the early morning hours, when burnout and fatigue are most prominent. The purpose of this study was to assess the effect of the ERR on the rate of clinically impactful "misses" and gauge resident feedback.

To assess implementation of the ERR role, R2-R4 overnight resident Flag M data from the pre- (2022-2023) and post-intervention (2023-2024) periods were compared. Residents were surveyed regarding perceived impact of the ERR.

The Flag M rate for overnight resident reports decreased from 1.28% in the pre-intervention period (614/48107 studies) to 0.92% in the post intervention period (435/47428 studies) (p-value<0.01). Most survey respondents (n = 32) either agreed or strongly agreed that working alongside an ERR allowed them to dedicate more attention to complex cases and ameliorated fatigue. Respondents who had worked as the ERR noted minimal impact to case volumes and improved handoffs/transitions between shifts.

Establishment of the ERR role resulted in a significant decrease in the rate of resident-interpreted reports with clinically significant misses. Resident feedback regarding the ERR is overwhelmingly positive.