Decision-making by residents on-call has 'miniscule' negative impact on patient care

The study consisted of the review of approximately 12,000 emergency diagnostic imaging exams that were interpreted after hours by residents. “In the midst of our research, a vigorous national debate began concerning the appropriate stage of radiology resident training prior to independent call, said Richard B. Ruchman, MD, lead author of the study. Specifically, the ACGME proposed and subsequently approved a new requirement that would mandate one year of residency training prior to independent call,” said Dr. Ruchman. “Our study examined the discrepancy rate by year of training, and attempted to answer the question whether it was safe for first year residents to take independent call with faculty back up,” he said.

The study showed that the major discrepancy rate (the rate which the interpretation by residents after hours disagreed with the attending physicians’ final interpretation and the difference in diagnosis had some negative affect on patient care) was 2.6 percent. A significant negative clinical effect of a discrepancy was only found in 0.3 percent. “This discrepancy rate is comparable to the discrepancy rates of the attending radiologists in our program,” Dr. Ruchman noted.

Most major discrepancies involved abdominal or chest examinations, with the most frequently missed or corrected diagnosis being acute appendicitis, Dr. Ruchman said. The second most commonly missed diagnosis was pulmonary embolism.

“The results of our study demonstrate that well-trained and supervised residents at all levels can interpret imaging studies safely,” said Dr. Ruchman. “The rate of significant adverse consequences was miniscule and, in fact, was not greater for residents in the early years of training. This should give a sense of confidence to referring physicians and patients that off-hour imaging studies are being interpreted accurately. It also suggests a re-examination of the ACGME's recent revision of the rule regarding resident independent on call duties,” he said.

The full results of this study appear in the September issue of the American Journal of Roentgenology, published by the American Roentgen Ray Society.