Overnight resident preliminary interpretations on CT Examinations: should the process continue?

We report our experience with resident preliminary interpretations given at night on both abdominal and neurological CT scans to quantify the discrepancy rate when compared to the final report. An attempt was also made to document any adverse clinical outcomes as a result of the preliminary interpretation. From January 1, 2004 to December 31, 2004, adult CT examinations were prospectively interpreted by residents at night at a level I trauma center. Both the neurological and body CT scans were reviewed beginning at 7:00 a.m. the following morning by the respective subspecialty staff and discrepancies were noted. Adult CT examinations (6,858) were prospectively interpreted by residents: 5,206 cranial spinal CT examinations and 1,652 body CT examinations. Among the neurological studies, there were six cases identified as major discrepancies (0.1%) and 185 minor discrepancies (3.5%). Among the body CT cases, there were seven cases identified as major discrepancies (0.4%) and 23 cases of minor discrepancies (1.4%). There is a low discrepancy rate (0.2% major and 3.1% minor) in the preliminary resident interpretations from the final report. The process of overnight preliminary CT interpretations should continue as it is not substandard care.Presented at the American Society of Emergency Radiology 2005 Annual Meeting, Tucson, Arizona.     

First year radiology residents not taking call: will there be a difference?

Currently, there is a debate in the academic radiology community about whether or not first year residents should take overnight call. The purpose of this study was to track discrepancies on overnight resident preliminary reads on radiographs from the emergency department to see if the experience level of the resident makes a difference. From October 1, 2005 to September 22, 2006, 13,213 radiographs were prospectively interpreted by residents at night at a Level I Trauma Center. Discrepancies were documented after review of the films with the staff radiologist in the morning. The patient’s medical record was then examined to determine if there was any adverse clinical outcome as a result of the reading. Of the 13,184 radiographs interpreted, 120 total discrepancies were identified (overall discrepancy rate 0.9%). First year residents showed a discrepancy rate of 1.59%, higher than other residents, which were ranged from 0.39 to 0.56%. Of the 54 patients with follow-up imaging, the abnormality that was felt to be present by staff persisted on follow-up imaging in 22 cases; however, the abnormality was not present on follow up of the other 32 patients (59.2% of discrepancies with follow-up imaging). Although there is higher rate of discrepancy among reports generated by first year residents, the difference compared to the other levels of experience is small, and its overall significance can be debated. Follow-up imaging often showed that staff interpretations were false positives when there was a discrepancy reported.     

The DePICTORS Study: discrepancies in preliminary interpretation of CT scans between on-call residents and staff

At many academic hospitals, radiology residents provide preliminary interpretations of CT studies performed outside of regular working hours. We examined the rate of discrepancies between resident interpretations and final reports issued by staff. We prospectively obtained 1,756 preliminary reports and corresponding final reports for computed tomography (CT) scans performed on call between November 2006 and March 2007. The overall rate of clinically significant discrepancies (those that would potentially alter the patient’s clinical course prior to issue of the final report) was 2.0%. Major discrepancy rates for abdominal/pelvic, chest, cervical spine and head CT were 4.1%, 2.5%, 1.0% and 0.7%, respectively. Senior residents had fewer major discrepancies compared to their junior colleagues. Time of interpretation was also evaluated, but a statistically significant relationship was not observed. In summary, this study demonstrates a low discrepancy rate between residents and staff radiologists and identifies areas where after-hours service may be further improved.     

The graveyard shift: experience with a night float system

The aim of this study is to describe the effects of a new night float system on the circadian rhythm and clinical judgment of our residents. In addition, the study looks at the residents' opinions of how to optimize the night float system in the future. All 20 of the radiology residents at our institution completed a questionnaire about the night float system after completing their night float coverage. The results of the questionnaire were then compiled and tabulated. It took our residents an average of 2.0 days to become acclimated to the night float and an average of 2.3 days to return to a normal daily routine after completing the night float. No residents perceived impairment in their clinical judgment while on the night float. However, 9 of the 20 residents (45%) stated that their clinical judgment was improved on the night float compared to that of a 24-hour call. Eighteen of 20 residents (90%) preferred the night float system to a 24-hour call system. On average, our residents believe that the optimal number of hours for a night float shift is 10.5 hours and the optimal numbers of days to do the night float consecutively is 6.8 days. In conclusion, a night float system can be a preferable means of evening coverage as it has a minimal effect on the circadian rhythm by allowing residents to become acclimated to working the night shift over the course of several days. The night float system also demonstrates no appreciable adverse effects on clinical judgment and may allow better clinical judgment than a 24-hour call system. Electronic Publication     

Radiology Resident Preliminary Reporting in an Independent Call Environment: Multiyear Assessment of Volume,Timeliness, and Accuracy

PurposeThe objective of this paper is to assess the volume, accuracy, and timeliness of radiology resident preliminary reports as part of an independent call system. This study seeks to understand the relationship between resident year in training, study modality, and discrepancy rate.MethodsResident preliminary interpretations on radiographs, ultrasound, CT, and MRI from October 2009 through December 2013 were prospectively scored by faculty on a modified RADPEER scoring system. Discrepancy rates were evaluated based on postgraduate year of the resident and the study modality. Turnaround times for reports were also reviewed. Differences between groups were compared with a chi-square test with a significance level of 0.05. Institutional review board approval was waived as only deidentified data were used in the study.ResultsA total of 416,413 studies were reported by 93 residents, yielding 135,902 resident scores. The rate of major resident–faculty assessment discrepancies was 1.7%. Discrepancy rates improved with increasing experience, both overall (PGY-3: 1.8%, PGY-4: 1.7%, PGY-5: 1.5%) and for each individual modality. Discrepancy rates were highest for MR (3.7%), followed by CT (2.4%), radiographs (1.4%), and ultrasound (0.6%). Emergency department report turnaround time averaged 31.7 min. The average graduating resident has been scored on 2,746 ± 267 reports during residency.ConclusionsResident preliminary reports have a low rate of major discrepancies, which improves over 3 years of call-taking experience. Although more complex cross-sectional studies have slightly higher discrepancy rates, discrepancies were still within the range of faculty report variation.     

Radiology resident interpretations of on-call imaging studies: the incidence of major discrepancies

RATIONALE AND OBJECTIVES: To determine the incidence of radiology resident preliminary interpretation errors for plain film, body computed tomography, and neuroradiology (neuro)computed tomographic examinations read on call. MATERIALS AND METHODS: We retrospectively reviewed the data in a prospectively acquired resident quality assurance (QA) database dating between January 2000 and March 2007. The database comprises all imaging studies initially interpreted by an on-call resident and later reviewed by a board-certified attending radiologist who determined the level of discrepancy between the two interpretations according to a graded scale from 0 (no discrepancy) to 3 (major discrepancy). We reviewed the data with respect to resident training level, imaging modality, and variance level. Statistical analysis was performed with chi(2) test, alpha = 0.05. We compared our results with other published series studying resident and attending accuracy. RESULTS: A total of 141,381 cases were entered into the database during the review period. Of all examinations, 95.7% had zero variance, 3.3% minor variance, and 1.0% major variance. There was a slight, statistically significant increase in overall accuracy with increased resident year from 95.4% of examinations read by first-year residents (R1s) to 96.1% by fourth-year resident (R4s) (P < .0001). Overall percentages of exams with major discrepancies were 1.0% for R1s, 1.1% for second-year residents, 1.0% for third-year residents, and 0.98% for R4s. CONCLUSIONS: The majority of preliminary resident interpretations are highly accurate. The incidence of major discrepancies is extremely low and similar, even with R1s, to that of attending radiologists published in other studies. A slight, statistically significant decrease in the error rate is detectable as residents gain experience throughout the 4 years of residency.     

The “night stalker” effect: Are quality improvements with a dedicated night call rotation sustained?

The authors assessed whether the addition of a second-year diagnostic radiology resident assigned to cover the night shift at a major urban university hospital has a sustained effect on the number and clinical significance of “missed” radiologic findings. Radiographs interpreted overnight in the emergency department by radiology residents between January 1992 and December 1992 were reviewed daily by emergency radiology attending staff. A list of patients for whom there was a modification in the final radiologic interpretation was given to the emergency department physicians, who reviewed each case, scored the urgency of patient recall, and estimated the likelihood of patient morbidity attributable to the miss. The relative performance of after-hours residents was compared on the five nights per week with the dedicated night resident vs. the two nights per week without the dedicated night resident (control group). Of 22,295 after-hours examinations performed during the study period, 304 (1.36%) misses were recorded, nearly identical to the miss rate for the preceding 6 months. The percentage per examination interpreted (and number) of missed cases stratified by recall score for the control and dedicated night resident groups, respectively, were: (a) immediate, 0.62% (34) and 0.29% (49); (b) within 48 hours, 0.31% (17) and 0.32% (54); (c) no recall, 0.71% (24) and 0.29% (39); (d) finding already recognized by emergency department physicians, 0.44% (24) and 0.23% (39); total, 2.09% (114) and 1.13% (190). The difference in total discordance rates is statistically significant (P < 1 × 10⁻¹⁵). Our previously reported improvement in the quality of after-hours radiographic interpretation due to the addition of a dedicated night shift resident is sustained in a new group of residents. This confirms that the improvement is real and not a manifestation of the measurement methods.     

Emergency imaging discrepancy rates at a level 1 trauma center: identifying the most common on-call resident “misses”

The focus of our research is to identify the most frequently reported on-call discrepancies at our hospital by modality and level of resident training. Our intent is to identify specific areas of concern that may be amenable to improvement through initiation of dedicated resident training in the field of emergency radiology. Our study included 648 significant discrepancies from 193,722 studies ordered through the emergency department over a 7-year period. The overall discrepancy rates were calculated for each resident level of training and modality type. Significance was determined using χ2 testing with α?=?0.05. The most common types of discrepancies were identified. The overall rate of reported discrepancies was low for all levels of training (0.23–0.42 %) with a small, but statistically significant, decrease in rate for the senior residents. Common categories of discrepancies for all residents included fractures on radiographs (XR) and computed tomography (CT), masses and hemorrhage on CT, and lung nodules and pulmonary infiltrates on radiographs. Specific discrepancies reported more frequently for new call-takers included phalangeal fractures on XR as well as white matter disease, hepatic lacerations, pyelonephritis, peritoneal fluid, lymphadenopathy, and pneumothoraces on CT. It is our recommendation that radiology resident training programs ensure that the common discrepancies illustrated herein are specifically addressed as part of a dedicated emergency radiology course.     

Preliminary interpretations of after-hours CT and sonography by radiology residents versus final interpretations by body imaging radiologists at a level 1 trauma center

OBJECTIVE: At many academic institutions, preliminary interpretations of CT scans and sonograms obtained after regular hours of operation are performed by radiology residents, with attending radiologists reviewing the interpretations the next morning. We sought to determine the rate of discrepancy between residents' interpretations of imaging studies and the final interpretations performed by an attending body imaging radiologist as well as any resulting clinical consequences stemming from the discrepancies. Therefore, we reviewed 928 CT and sonographic images that had been obtained after hours at a level 1 trauma center during a 6-month period. MATERIALS AND METHODS: Any discrepancies between the preliminary and final interpretations were judged as either major (i.e., necessitating an urgent change in treatment) or minor errors. We conducted patient follow-up via a retrospective review of the medical charts to determine whether any of the discrepancies led to additional imaging, an increase in patient morbidity, an extension of a hospital stay, or a change in treatment. RESULTS: The overall discrepancy rate in interpretations rendered by the residents and those performed by the attending radiologist was 3.8%, with most of these discrepancies (86%) judged to be minor. If we combined the data for body CT scans and sonograms, the rate of minor discrepancies was 3.2%, and the rate of major discrepancies was 0.5%. If we considered only body CT data in the evaluation, the overall discrepancy rate increased to 6.4%, with a 5.4% rate of minor discrepancies and a 1.0% rate of major discrepancies. CONCLUSION: Our evaluation of discrepancy rates was unusual in that we included interpretations of sonograms, on which residents and the attending radiologist had a higher rate of agreement (99.5%). Because of the high agreement in the interpretation of sonograms, the overall discrepancy rate was 3.8%. However, if only body CT scan interpretations were evaluated, our results were closer to the rates reported in previously published studies. Major discrepancies led to a change in patient treatment but did not lead to any increase in patient morbidity or to any quantifiable increase in the length of the hospital stay.     

24/7/365 Neuroradiologist Coverage Improves Resident Perception of Educational Experience,Referring Physician Satisfaction,and Turnaround Time

PurposeTo quantitatively and qualitatively assess the impact of attending neuroradiology coverage on radiology resident perceptions of the on-call experience, referring physician satisfaction, and final report turnaround times.Materials and Methods24/7/365 attending neuroradiologist coverage began in October 2016 at our institution. In March 2017, an online survey of referring physicians, (emergency medicine, neurosurgery, and stroke neurology) and radiology residents was administered at a large academic medical center. Referring physicians were queried regarding their perceptions of patient care, report accuracy, timeliness, and availability of attending radiologists before and after the implementation of overnight neuroradiology coverage. Radiology residents were asked about their level of independence, workload, and education while on-call. Turnaround time (TAT) was measured over a 5-month period before and after the implementation of overnight neuroradiology coverage.ResultsA total of 28 of 64 referring physicians surveyed responded, for a response rate of 67%. Specifically, 19 of 23 second (junior resident on-call) and third year radiology residents (senior resident on-call) replied, 4 of 4 stroke neurology fellows replied, 8 of 21 neurosurgery residents, and 16 of 39 emergency medicine residents replied. Ninety-five percent of radiology residents stated they had adequate independence on call, 100% felt they have enough faculty support while on call, and 84% reported that overnight attending coverage has improved the educational value of their on-call experience. Residents who were present both before and after the implementation of TAT metrics thought their education, and independence had been positively affected. After overnight neuroradiology coverage, 85% of emergency physicians perceived improved accuracy of reports, 69% noted improved timeliness, and 77% found that attending radiologists were more accessible for consultation. The surveyed stroke neurology fellows and neurosurgery residents reported positive perception of the TAT, report quality, and availability of accessibility of attending radiologist.ConclusionsIn concordance with prior results, overnight attending coverage significantly reduced turnaround time. As expected, referring physicians report increased satisfaction with overnight attending coverage, particularly with respect to patient care and report accuracy. In contrast to some prior studies, radiology residents reported both improved educational value of the on-call shifts and preserved independence. This may be due to the tasking the overnight neuroradiology attending with dual goals of optimized TAT, and trainee growth. Unique implementation including subspecialty trained attendings may facilitate radiology resident independence and educational experience with improved finalized report turnaround.     

On-Call Radiology Resident Discrepancies: Categorization by Patient Location and Severity

PurposeTo report discrepancy rates for examinations interpreted by on-call residents overall and by resident training level, and to describe a novel discrepancy classification system based on patient location and severity that facilitates recording of discrepancy data, helps ensure proper communication of report changes, and allows our radiology department to assume responsibility for contacting discharged patients with non-time-dependent results.MethodsA HIPAA-compliant, institutional review board–exempt review of two years (January 2013 to December 2014) of discrepancy data was retrospectively performed for total number of examination interpreted, discrepancy rates, resident training level, and discrepancy categories. Most common diagnoses and means of results communication for discharged patients were also recorded.ResultsRadiology residents interpreted 153,420 examinations after hours and had 2169 discrepancies, for an overall discrepancy rate of 1.4%. Discrepancy rates for postgraduate year (PGY)-3, PGY-4, and PGY-5 residents were 1.31%, 1.65%, and 1.88%, respectively. The rate of critical discrepancies was extremely low (10/153,420 or 0.007%). A total of 502 patients (23.2% of all discrepancies) were discharged at the time their discrepancy was identified, 60% of whom had non-time-dependent discrepancies that were communicated by radiologists; 32.4% of these had addended results telephoned to a PCP, 43.4% had addended results telephoned to the patient, and the remaining 24.2% required a registered letter. Eight percent of patients with non-time-dependent findings were lost to follow-up.ConclusionsOur resident discrepancy rates were comparable to those published previously, with extremely low rates of critical discrepancies. Radiologists assumed responsibility for contacting the majority of discharged patients with discrepant results, a minority of whom were lost to follow-up.     

Preliminary Reports in the Emergency Department: Is a Subspecialist Radiologist More Accurate Than a Radiology Resident?

RATIONALE AND OBJECTIVES: To determine whether emergency department (ED) preliminary reports rendered by subspecialist attending radiologists who are reading outside their field of expertise are more accurate than reports rendered by radiology residents, and to compare error rates between radiologists and nonradiologists in the ED setting. MATERIALS AND METHODS: The study was performed at a large academic medical center with a busy ED. An electronic preliminary report generator was used in the ED to capture preliminary interpretations rendered in a clinical setting by radiology residents, junior attendings (within 2 years of taking their oral boards), senior attendings, and ED clinicians between August 1999 and November 2004. Each preliminary report was later reviewed by a final interpreting radiologist, and the preliminary interpretation was adjudicated for the presence of substantial discordances, defined as a difference in interpretation that might immediately impact the care of the patient. Of the 612,890 preliminary reports in the database, 65,780 (11%) met inclusion criteria for this study. A log-linear analysis was used to assess the effects of modality and type of author on preliminary report error rates. RESULTS: ED clinicians had significantly higher error rates when compared with any type of radiologist, regardless of modality. Within the radiologists, residents and junior attendings had lower error rates than did senior attendings, but the differences were not statistically significant. CONCLUSION: Subspecialized attending radiologists who interpret ED examinations outside their area of expertise have error rates similar to those of radiology residents. Nonradiologists have significantly higher error rates than radiologists and radiology residents when interpreting examinations in the ED.     

Ampakine (CX717) effects on performance and alertness during simulated night shift work

INTRODUCTION: Round-the-clock operations in both military and civilian sectors have increased the need for alertness- and performance-maintaining strategies. The potential performance and objective alertness-enhancing effects of CX717 (a novel cognitive enhancer currently being tested in Phase II clinical trials) were evaluated using a simulated night shift work paradigm. METHODS: In this randomized, double-blind, placebo-controlled, parallel groups design, 48 volunteers underwent 4 consecutive nights of simulated shift work. Each "shift" consisted of the following: at approximately 2145 (just prior to the start of each simulated night shift), volunteers ingested a single oral dose of CX717 200 mg, CX717 400 mg, CX717 1000 mg, or placebo (N = 12 per drug dosage). Performance, alertness, mood, and symptoms were then assessed from 2300 to 0700, followed by a polysomnographically monitored daytime sleep period from 0800 to 1200. RESULTS: Performance and alertness significantly degraded across the simulated night shifts (P < 0.05). None of the dosages of CX717 reversed these effects (P > 0.05). CX717 exerted some effects on daytime sleep, most notably reduction of slow-wave sleep time (P < 0.05). CX71 7 caused very few side effects and none of those were serious or unexpected. DISCUSSION AND CONCLUSIONS: At the doses tested, CX717 was not effective for reversing performance and alertness deficits associated with night shift work. Further work evaluating higher doses of CX717 may be warranted, as are studies in which CX717 effects are explored under other conditions (e.g., Alzheimer's dementia, attention deficit disorder).     

Performance and quality of sleep wearing NBC protective clothing

Two separate studies were carried out to investigate the effect of wearing nuclear-biological-chemical aircrew equipment assembly (NBC AEA) protective clothing on performance and on overnight sleep. Performance at a series of tasks was measured, in six male subjects, during the day (0800-2000 hours) and at night (2000-0800 hours). Wearing the NBC assembly did not lead to significant decrements in performance compared with the normal aircrew equipment assembly (AEA). The sleep of six male volunteers was recorded electroencephalographically on two consecutive nights when NBC protective clothing was worn. Sleep was both shortened and disturbed, compared with overnight control sleep. There were some improvements on the second night, suggesting that individuals may adapt to wearing the NBC assembly.     

Radiology resident evaluation of head CT scan orders in the emergency department

BACKGROUND AND PURPOSE: Prior studies have revealed little difference in residents' abilities to interpret cranial CT scans. The purpose of this study was to assess the performance of radiology residents at different levels of training in the interpretation of emergency head CT images. METHODS: Radiology residents prospectively interpreted 1324 consecutive head CT scans ordered in the emergency department at the University of Arizona Health Science Center. The residents completed a preliminary interpretation form that included their interpretation and confidence in that interpretation. One of five neuroradiologists with a Certificate of Added Qualification subsequently interpreted the images and classified their assessment of the residents' interpretations as follows: "agree," "disagree-insignificant," or "disagree-significant." The data were analyzed by using analysis-of-variance or chi-squared methods. RESULTS: Overall, the agreement rate was 91%; the insignificant disagreement rate, 7%; and the significant disagreement rate, 2%. The level of training had a significant (P =.032) effect on the rate of agreement; upper-level residents had higher rates of agreement than those of more junior residents. There were 62 false-negative findings. The most commonly missed findings were fractures (n = 18) and chronic ischemic foci (n = 12). The most common false-positive interpretations involved 10 suspected intracranial hemorrhages and suspected fractures. CONCLUSION: The level of resident training has a significant effect on the rate of disagreement between the preliminary interpretations of emergency cranial CT scans by residents and the final interpretations by neuroradiologists. Efforts to reduce residents' errors should focus on the identification of fractures and signs of chronic ischemic change.     

Sleep and cognitive performance of flight nurses after 12-hour evening versus 18-hour shifts

BACKGROUND: Inadequate rest can result in disastrous medical and aviation errors. Using a prospective within-subjects design, this study compared the amount of daily sleep and the cognitive performance in flight nurses working 12-hour evening versus 18-hour shifts during a 72-hour duty schedule. METHODS: Ten flight nurses who worked two different duty schedules participated in the study. The first duty schedule consisted of three back-to-back 12-hour (7:00 pm to 7:00 am) evening shifts. The second duty schedule consisted of two 18-hour (7:00 am to 1:00 am) shifts separated by a 24-hour rest period. Pre- and duty sleep times were monitored using actigraphy. The flight nurses were tested using a battery of neuropsychological tests before and immediately after completing 12- and 18-hour duty schedules. After the conclusion of both duty schedules, nurses were asked to rate the 12- versus 18-hour duty schedules via questionnaire. RESULTS: Daily sleep times for the 12- versus 18-hour were not different for the pre-duty schedule (8.9 +/- 2.3 vs. 9.0 +/- 2.3 hours) or during duty schedule (7.0 +/- 1.4 vs. 6.9 +/- 1.3 hours). A significant decline was seen in the amount of pre- versus duty sleep for both the 12-hour (8.9 +/- 2.3 vs. 7.0 +/- 1.4 hours; P < .05) and the 18-hour (9.0 +/- 2.3 vs. 6.9 +/- 1.3 hours; P = .04) duty schedules. During the 72-hour duty schedule, the 12-hour vs. 18-hour duty schedules, the nurses had less pre-shift sleep (3.2 +/- 1.2 vs. 6.2 +/- 0.6; P = .001) and more on-shift (4.4 +/- 1.7 vs. 2.1 +/- 0.8; P = .002) sleep. Despite the decline in daily sleep during both duty schedules, no significant decline in the before versus after cognitive test scores were observed for either the 12- or 18-hour duty schedule. A questionnaire given to the 10 nurses indicated that the 18-hour duty schedule was more compatible with their non-work lifestyle (P = .04). CONCLUSIONS: Provided adequate daily sleep (at least 7 hours/day) is obtained, we found no difference or decline in the cognitive function of flight nurses working either a 12-hour evening or 18-hour shift during a 72-hour duty schedule. Eighteen-hour duty shifts may be a practical economical means of expanding the period of helicopter site coverage without adversely affecting cognitive performance in medical crewmembers. Actigraphy may be a useful tool for air medical programs that want to objectively assess whether adequate sleep is occurring in individuals working extended (>12 hours) or unusual duty shifts.     

The 12-hour shift: radiographers’ perspectives and its applicability during a pandemic

IntroductionTraditionally, shift work for radiographers at our institution comprised of three shift patterns – morning (8am-2pm), afternoon (2pm–9pm) and night (9pm-8am). However, when COVID-19 was first detected in Singapore in January 2020, the 12-h shift was introduced for better team segregation and deployment to meet the service needs of the Emergency Department. The 12-h shift consisted of the day (9am-9pm) and night (9pm-9am) shifts. While the 12-h shift is common to nursing practices, it is new to the radiography profession within the study centre. This study explores the radiographers' perspectives of the new shift and the impact of shift patterns on radiographers' wellness and work performance compared to the original three shift patterns.MethodsA mixed-methods design study was adopted for this single-centre evaluation. An anonymous online questionnaire was administered to radiographers who had experienced both shift types. Additionally, the number of radiographers who had taken sick leave, and images rejected and accepted from the X-ray consoles were retrospectively collected to measure the impact of the new shift.ResultsRadiographers experienced fatigue and appreciated the longer rest days associated with the 12-h shift. Additionally, the sick leave rates and image reject counts were more favourable with the 12-h shift pattern.ConclusionThe findings indicate that the extended shift hours are effective during a pandemic but may result in radiographer burnout during a prolonged outbreak.Implications for practiceStudying these variables will provide an effective starting point in understanding the efficacy and applicability of a 12-h shift system during pandemic periods.     

Usefulness of temazepam and zaleplon to induce afternoon sleep

Insufficient daytime sleep may result in reduction of effectiveness and safety during overnight military missions. The usefulness of temazepam and zaleplon to optimize afternoon sleep and their effects on performance and alertness during a subsequent night shift were studied. Method: In a randomized double-blind within-subjects design, 11 subjects took 20 mg of temazepam, 10 mg of zaleplon, or placebo before a 5:30-10:00 p.m. sleep period. Sleep length and quality were measured. Subjects were kept awake throughout the night while alertness, cognitive performance, and muscle power were repeatedly measured. Results: Temazepam provided significantly longer and qualitatively better sleep than zaleplon or placebo. During the night, sleepiness increased and muscle power was impaired in all conditions. Better sleep was correlated with less sleepiness during the night. Conclusion: Temazepam is useful to optimize a 4.5-hour afternoon sleep before overnight missions. Irrespective of hypnotic treatment, sleepiness and fatigue increased during the night shift.     

Ensuring Appropriateness of Pediatric Second Opinion Consultations

PurposeWe sought to evaluate discrepancy rates between outside interpretations, radiology trainee preliminary reports, and subspecialist attending final interpretations for pediatric second opinion consultations on plain film and computed tomography imaging and to evaluate the impact of a process improvement for second opinion consultations.MethodsOf a total of 572 requests for second opinion consultations during 1-year preintervention period, we utilized RADPEER to score concurrence of 158 requests which occurred overnight and included outside radiologist interpretations and resident preliminary reports. In consultation with clinician committees, we developed new guidelines for requesting second opinion consultations. We evaluated the impact on the number of consultations for the 1-year period following implementation of this process improvement.ResultsThere was concurrence between the outside interpretation and pediatric subspecialist second opinion in 146 of 158 cases (92%). There was concurrence between the radiology resident and pediatric subspecialist second opinion in 145 of 158 cases (92%). During the 1-year period following our process improvement implementation, the total number of second opinion consultations decreased to 185 (from 572, a decrease of 68%) and the number of overnight requests for resident preliminary reports decreased to 11 (from 158, a decrease of 93%).ConclusionsThere was a high degree of concurrence between interpretations provided by outside radiologists, overnight radiology residents, and attending pediatric radiologists at our institution. Analyzing institutional-specific discrepancy rates is a valuable first step in partnering with clinicians to develop appropriate guidelines for second opinion consultations.     

Rapid counterclockwise shift rotation in air traffic control: effects on sleep and night work

INTRODUCTION: In Air Traffic Control, counterclockwise rapidly rotating shift schedules are often employed but may result in significant sleep loss. This has potential consequences for performance, particularly if a night shift is worked. As part of a large-scale field study, the pattern of sleep across a 4-d counterclockwise, rapidly rotating schedule (afternoon, day, morning, night shift) was documented and relationships between prior sleep and performance during the night shift were investigated. METHODS: There were 28 controllers who completed 4 periods of data collection which included 2 d before and 2 d after a 4-d shift cycle. Sleep was recorded using an actigraph and sleep diary, and performance on each night shift was measured three times using the Psychomotor Vigilance Task. RESULTS: Across the work week, sleep duration decreased largely due to earlier rise times associated with shift start times moving backward. In the short turn-around between the morning and night shift, 90% of controllers slept for an average of 2.2 h. Improved performance on the night shift was related only to longer periods of sleep the night prior. DISCUSSION: This study demonstrates that a 4-d counterclockwise, rapidly rotating schedule results in a progressive reduction in sleep and consequently the rapid accumulation of a sleep debt. To help maintain their performance on the night shift, it is recommended that controllers attempt to obtain at least 6 h sleep the night before a night shift. It is also recommended that ATC providers educate their workforce about this issue.