Abstract
Quantify resident caseload during call and determine if there are consistent differences in call volumes for individuals or resident subgroups. Accession codes for after-hours computed tomography (CT) cases dictated by residents between July 1, 2012 and January 9, 2017 were reviewed. Case volumes by patient visits and body regions scanned were determined and categorized according to time period, year, and individual resident. Mean shift Relative Value Units (RVUs) were calculated by year. Descriptive statistics, linear mixed modeling, and linear regression determined mean values, differences between residents, associations between independent variables and outcomes, and changes over time. Consistent differences between residents were assessed as a measure of good or bad luck / karma on call. During this time there were 23,032 patients and 30,766 anatomic regions scanned during 1,652 call shifts among 32 residents. Over the whole period, there were on average 10.6 patients and 14.3 body regions scanned on weekday shifts and 22.3 patients and 29.4 body regions scanned during weekend shifts. Annually, the mean number of patients, body regions, and RVUs scanned per shift increased by an average of 0.2 (1%), 0.4 (2%), and 1.2 (5%) (all p < 0.05) respectively in regression models. There was variability in call experiences, but only 1 resident had a disproportionate number of higher volume calls and fewer lower volume shifts than expected. Annual increases in scan volumes were modest. Although residents' experiences varied, little of this was attributable to consistent personal differences, including luck or call karma.
Highlights
Across different disciplines in medicine, after-hours medical care is evolving toward more service availability outside of regular working hours.[1,2,3] Correspondingly, imaging studies are viewed as standard components of patient care regardless of the hour of the day.[4,5] This is highlighted by a 45-75% increase in afterhours imaging volumes reported in Toronto between 2006 and 2013, with computed tomography (CT) as the dominant modality.[4]
Over the whole study period, the mean number of scans per shift was 10.6 + 3.7 on weeknights and 22.3 + 5.3 for weekends; the corresponding mean number of body regions scanned per shift was 14.3 + 5.6 and 29.4 + 8.0 respectively (Table 1)
In adjusting the association by scans per shift, we found that even if the number of scans remained constant, shift relative value units (RVU) still increased by an average of 0.8 RVU per year (p < 0.0001) indicating increasing scan complexity during the study period
Summary
Across different disciplines in medicine, after-hours medical care is evolving toward more service availability outside of regular working hours.[1,2,3] Correspondingly, imaging studies are viewed as standard components of patient care regardless of the hour of the day.[4,5] This is highlighted by a 45-75% increase in afterhours imaging volumes reported in Toronto between 2006 and 2013, with computed tomography (CT) as the dominant modality.[4]. It had been felt anecdotally that resident medical imaging call at our institution was becoming more demanding, with perceived higher patient volumes and caseload variation between shifts and, possibly, between residents. This perception of higher volume shifts was based on resident recall and experience. There were no recent changes to departmental equipment or imaging protocols that would have been expected to increase case volumes
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