Timothy Kerrigan, MD

A few points ED providers may not realize about Radiology workflow that doesn't get communicated well: -During the evening and nights, there is often only 1–2 radiologists covering multiple EDs, sometimes 6 or more. All studies appear on a single list organized by exam completion time and are read oldest to newest. -To an ED provider (I’ve been in this role before, so I’m talking from experience), it looks misleadingly simple: I have this patient I want to order a CTA Head/Neck on, what’s the big deal? To that one provider it may be the only CTA Head/Neck they order that night. -The reality is there may be multiple ED providers in a single department doing the same thing. Multiply this by the multiple ED departments these few radiologists are covering and now you’ve got a steady stream of CTAs coming all night. -If this were a study that takes a few minutes to read, like a non-con CT head, it’s not a problem. We can keep up with the flow of studies being ordered and get you all timely reports back. But when a single study takes anywhere from 15–45 minutes to read, as CTA Head/Necks do, 10 of these studies ordered in a short time span have suddenly created hours upon hours of work. You’ve just knocked out perhaps the only radiologist covering your hospital at night from reading any of the other patients’ studies for hours. -This creates frustration for both the radiologist and ED providers. Radiology falls behind, the ED is waiting hours for reports, not understanding what’s taking so long, and patients inadvertently suffer. They get sick of waiting and leave AMA, sometimes before their study can even be read. Diagnoses are delayed with downstream effects. Providers really concerned about their patient call us asking for a priority read; this further delays all the other studies from being read. And each time a Code Stroke study comes through, we drop everything and read those studies immediately, creating yet more delays. This is how one single study being over-ordered freezes an entire Emergency Department. Radiologists complaining about reading a study is odd when you think about it. It’s our job to read studies and most of us enjoy it, so why would we single out this CTA Head/Neck exam above others? And that is perhaps the biggest clue that something much bigger than just reading a study is going on in the background. At minimum, I would love to put screens in the ED department so all the providers can see the list of studies we’re reading and where we are on the list. To be fair, we can also put a screen in radiology with the ED patient queue so we can also appreciate how many patients the ED is seeing, which is greater than the number that get imaging ordered. A better understanding of both of our workflows is a good starting point for finding solutions, together. teapaw.org/TimKerriganMD/status/2…