Overnight Subspecialty Radiology Coverage: Review of a Practice Model and Analysis of Its Impact on CT Utilization Rates in Academic and Community Emergency Departments

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The purpose of this study is to describe a new practice model (overnight subspecialty radiology coverage) and to determine its impact on CT utilization rates in academic and community emergency departments. Overnight subspecialty (neuroradiology and abdominal imaging) attending coverage was instituted at the University of Pittsburgh Medical Center in 2008. Previously, preliminary interpretations of CT studies performed at four academic emergency departments were provided by radiology residents. Interpretations were provided to five community emergency departments by either a senior resident or a contracted teleradiology service. Rotating shifts of neuroradiologists and abdominal imagers have since provided contemporaneous final reports for emergency department CT studies from 5:00 pm to 7:00 am. We compared total CT volume, emergency department visits, and CT "intensity" (CT volume / emergency department visits) within academic and community hospitals 12 months before and after institution of overnight coverage. We also compared on-call (5:00 pm to 7:00 am) and daytime CT intensity in academic and community emergency departments during these time periods. Academic emergency department visits increased 7% and community emergency department visits decreased 3% during the study period. Total academic emergency department CT volume increased 8%, and community emergency department CT volume increased 9%. Daytime community emergency department CT volume remained constant, but on-call CT volume increased 16%. Academic emergency department CT intensity remained constant at 0.57, whereas community emergency department CT intensity increased from 0.40 to 0.45 (12.5%). Institution of overnight subspecialty emergency department coverage resulted in a disproportionate increase in CT utilization in community emergency departments. We hypothesize that community emergency departments lacking in-house clinical subspecialists may be more apt to use subspecialist radiology interpretations for patient management. Overnight subspecialty coverage increases CT utilization in the community emergency department, but the appropriateness and clinical impact is uncertain and in need of exploration.