Advertisement

Do Telephone Call Interruptions Have an Impact on Radiology Resident Diagnostic Accuracy?

  • Brad J. Balint
    Affiliations
    Department of Radiology and Imaging Sciences, Indiana University School of Medicine, Indiana University Health Methodist Hospital, 1701 N. Senate Blvd, Rm AG-176, Indianapolis, IN 46202
    Search for articles by this author
  • Scott D. Steenburg
    Correspondence
    Address correspondence to: S.D.S.
    Affiliations
    Department of Radiology and Imaging Sciences, Indiana University School of Medicine, Indiana University Health Methodist Hospital, 1701 N. Senate Blvd, Rm AG-176, Indianapolis, IN 46202
    Search for articles by this author
  • Hongbu Lin
    Affiliations
    Indiana University School of Medicine, Department of Biostatistics and the Indiana University Fairbanks School of Public Health, Indianapolis, Indiana
    Search for articles by this author
  • Changyu Shen
    Affiliations
    Indiana University School of Medicine, Department of Biostatistics and the Indiana University Fairbanks School of Public Health, Indianapolis, Indiana
    Search for articles by this author
  • Jennifer L. Steele
    Affiliations
    Department of Radiology and Imaging Sciences, Indiana University School of Medicine, Indiana University Health Methodist Hospital, 1701 N. Senate Blvd, Rm AG-176, Indianapolis, IN 46202

    Division of Radiology Education, Department of Radiology and Imaging Sciences, Indiana University School of Medicine, Indianapolis, Indiana
    Search for articles by this author
  • Richard B. Gunderman
    Affiliations
    Department of Radiology and Imaging Sciences, Indiana University School of Medicine, Indiana University Health Methodist Hospital, 1701 N. Senate Blvd, Rm AG-176, Indianapolis, IN 46202

    Division of Radiology Education, Department of Radiology and Imaging Sciences, Indiana University School of Medicine, Indianapolis, Indiana
    Search for articles by this author
Published:September 30, 2014DOI:https://doi.org/10.1016/j.acra.2014.08.001

      Rationale and Objectives

      The purpose of this study was to measure the effect of distractions, in the form of telephone call interruptions, on radiology resident diagnostic accuracy.

      Materials and Methods

      Radiology resident discrepancy reports and reading room telephone logs at an academic tertiary care pediatric hospital were collected over a 13-month period. Phone call times and durations were recorded. Major discrepancy shifts (defined as a call shift where at least one major discrepancy was discovered the following morning by the attending radiologist between the resident preliminary and attending final reports), and dictation time stamps for each discrepant preliminary dictation were also recorded. Telephone call volume and preliminary report time stamps were compared between “discrepancy shifts” and “no discrepancy shifts.”

      Results

      Each call shift spanned 14 hours, during which one radiology resident was responsible for the generation of preliminary interpretations. Review of the discrepancy log data revealed 51 major discrepancies in 41 shifts, of which 39 discrepancies had documented error details and resident preliminary report time stamps. The average number of telephone calls for the “discrepancy shifts” was slightly greater than the “no discrepancy shifts” (48.59 vs. 44.02) but was not statistically significant (P = .0575). However, there was a statistically significant increase in the average number of phone calls in the 1 hour preceding the generation of a discrepant preliminary report versus the “no discrepancy shifts” (4.23 vs. 3.24 calls, P = .027). One additional phone call during the hour preceding the generation of a discrepant preliminary report resulted in a 12% increased likelihood of a resident error (P = .017).

      Conclusions

      Distractions in the form of telephone call interruptions may negatively impact on-call radiology resident diagnostic accuracy. Efforts should be made to limit distractions in the reading room.

      Key Words

      To read this article in full you will need to make a payment

      Purchase one-time access:

      Academic & Personal: 24 hour online accessCorporate R&D Professionals: 24 hour online access
      One-time access price info
      • For academic or personal research use, select 'Academic and Personal'
      • For corporate R&D use, select 'Corporate R&D Professionals'

      Subscribe:

      Subscribe to Academic Radiology
      Already a print subscriber? Claim online access
      Already an online subscriber? Sign in
      Institutional Access: Sign in to ScienceDirect

      References

        • Froehle C.M.
        • White D.L.
        Interruption and forgetting in knowledge-intensive service environments.
        Prod Oper Manag. 2013; 23: 704-722
      1. Kohn L.T. Corrigan J. Donaldson M.S. To err is human: building a safer health system. National Academy Press, Washington, District of Columbia2000
        • Stelfox H.T.
        • Palmisani S.
        • Scurlock C.
        • et al.
        The “To Err is Human” report and the patient safety literature.
        Qual Safety Health Care. 2006; 15: 174-178
        • Sittig D.F.
        • Singh H.
        Electronic health records and national patient-safety goals.
        N Engl J Med. 2012; 367: 1854-1860
        • Radecki R.P.
        • Sittig D.F.
        Application of electronic health records to the Joint Commission's 2011 National Patient Safety Goals.
        JAMA. 2011; 306: 92-93
        • Blendon R.J.
        • DesRoches C.M.
        • Brodie M.
        • et al.
        Views of practicing physicians and the public on medical errors.
        N Engl J Med. 2002; 347: 1933-1940
        • Einstein G.O.
        • McDaniel M.A.
        • Williford C.L.
        • et al.
        Forgetting of intentions in demanding situations is rapid.
        J Exp Psychol Appl. 2003; 9: 147-162
        • Eyrolle H.
        • Cellier J.M.
        The effects of interruptions in work activity: field and laboratory results.
        Appl Ergon. 2000; 31: 537-543
        • Meeks D.W.
        • Takian A.
        • Sittig D.F.
        • et al.
        Exploring the sociotechnical intersection of patient safety and electronic health record implementation.
        J Am Med Inform Assoc. 2014; 21: e28-e34
      2. Joint Commission Center for Transforming Healthcare, SCHA collaborate on high-reliability program.
        Bull Am Coll Surg. 2013; 98: 65
        • McGillis Hall L.
        • Pedersen C.
        • Fairley L.
        Losing the moment: understanding interruptions to nurses' work.
        J Nurs Adm. 2010; 40: 169-176
        • Sorensen E.E.
        • Brahe L.
        Interruptions in clinical nursing practice.
        J Clin Nur. 2013; 23: 1274-1282
        • Hall L.M.
        • Ferguson-Pare M.
        • Peter E.
        • et al.
        Going blank: factors contributing to interruptions to nurses' work and related outcomes.
        J Nurs Manag. 2010; 18: 1040-1047
        • Arora S.
        • Hull L.
        • Sevdalis N.
        • et al.
        Factors compromising safety in surgery: stressful events in the operating room.
        Am J Surg. 2010; 199: 60-65
        • Yu J.P.
        • Kansagra A.P.
        • Mongan J.
        The radiologist's workflow environment: evaluation of disruptors and potential implications.
        J Am Coll Radiol. 2014; 11: 589-593
        • Levin D.C.
        • Rao J.M.
        • Parker L.
        • et al.
        Analysis of radiologists' imaging workload trends by place of service.
        J Am Coll Radiol. 2013; 10: 760-763
        • Rosenstein A.H.
        • Mudge-Riley M.
        The impact of stress and burnout on physician satisfaction and behaviors.
        Physician Exec. 2010; 36 (20, 22-3): 16-18
        • Holt G.R.
        Physician burnout: a serious concern for the medical profession.
        South Med J. 2013; 106: 297
        • Shanafelt T.
        • Dyrbye L.
        Oncologist burnout: causes, consequences, and responses.
        J Clin Oncol. 2012; 30: 1235-1241
        • Dhanoa D.
        • Dhesi T.S.
        • Burton K.R.
        • et al.
        The evolving role of the radiologist: the Vancouver workload utilization evaluation study.
        J Am Coll Radiol. 2013; 10: 764-769
        • Cooper V.F.
        • Goodhartz L.A.
        • Nemcek Jr., A.A.
        • et al.
        Radiology resident interpretations of on-call imaging studies: the incidence of major discrepancies.
        Acad Radiol. 2008; 15: 1198-1204
        • Flink C.C.
        • Mueller J.S.
        • Kiproff P.M.
        Impact of resident call eligibility on major discrepancy rate.
        Acad Radiol. 2010; 17: 1299-1301
        • Maloney E.
        • Lomasney L.M.
        • Schomer L.
        Application of the RADPEER scoring language to interpretation discrepancies between diagnostic radiology residents and faculty radiologists.
        J Am Coll Radiol. 2012; 9: 264-269
        • Miyakoshi A.
        • Nguyen Q.T.
        • Cohen W.A.
        • et al.
        Accuracy of preliminary interpretation of neurologic CT examinations by on-call radiology residents and assessment of patient outcomes at a level I trauma center.
        J Am Coll Radiol. 2009; 6: 864-870
        • Ruchman R.B.
        • Jaeger J.
        • Wiggins III, E.F.
        • et al.
        Preliminary radiology resident interpretations versus final attending radiologist interpretations and the impact on patient care in a community hospital.
        AJR Am J Roentgenol. 2007; 189: 523-526
        • Ruma J.
        • Klein K.A.
        • Chong S.
        • et al.
        Cross-sectional examination interpretation discrepancies between on-call diagnostic radiology residents and subspecialty faculty radiologists: analysis by imaging modality and subspecialty.
        J Am Coll Radiol. 2011; 8: 409-414
        • Shah N.A.
        • Hoch M.
        • Willis A.
        • et al.
        Correlation among on-call resident study volume, discrepancy rate, and turnaround time.
        Acad Radiol. 2010; 17: 1190-1194
        • Walls J.
        • Hunter N.
        • Brasher P.M.
        • et al.
        The DePICTORS study: discrepancies in preliminary interpretation of CT scans between on-call residents and staff.
        Emerg Radiol. 2009; 16: 303-308
        • Altmann E.M.
        • Trafton J.G.
        • Hambrick D.Z.
        Momentary interruptions can derail the train of thought.
        J Exp Psychol Gen. 2014; 143: 215-226
      3. “The Biggest Office Interruptions Are…” Available at: http://online.wsj.com/news/articles/SB10001424127887324123004579057212505053076. Accessed December 18, 2013.

        • Lindsay R.
        • McKinstry S.
        • Vallely S.
        • et al.
        What influences clinician's satisfaction with radiology services?.
        Insights Imaging. 2011; 2: 425-430