Coverage of emergency after-hours ultrasound cases: survey of practices at U.S. Teaching hospitals

RATIONALE AND OBJECTIVES: Diagnostic ultrasound examinations may be performed after-hours by physicians if technologists are not available or cases are complex. Our experience suggested there is wide variability in how ultrasound coverage is provided after-hours, which motivated us to conduct a formal survey of teaching programs around the country. METHODS: Four hundred five members of the Association of Program Directors in Radiology were contacted by e-mail and sent a link to a five-part questionnaire posted on the Web. Respondents were asked whether ultrasound cases after-hours are performed in their institutions by radiology residents, technologists on the premises after-hours, technologists on-call, or some combination. Data on the type of program, number of beds in the primary hospital, number of residents in the program, and geographic location of the program were recorded. Responses were automatically written to a data file stored on a Web server and the imported into an Excel spreadsheet for data analysis. A chi(2) analysis was performed to assess associations among the variables and statistical significance. RESULTS: A total of 79 programs responded to the survey. Of those, 32% provided coverage with ultrasound technologists on call, 24% by ultrasound technologists on the premises, 13% provided combination coverage, and 10% provided coverage solely with residents on call. There was no association among number of residents in the program, location of the program, or type of program (university, community, or affiliated) and type of coverage provided. CONCLUSION: There is wide variability in methods for providing coverage of after-hours ultrasound cases. However, on-site or on-call coverage of emergency cases by technologists did not appear to depend significantly on program location, program type, or program size.     

Alaska air carrier operator and pilot safety practices and attitudes: a statewide survey

INTRODUCTION: Aviation crashes are a leading cause of occupational fatalities in Alaska, with Alaskan pilots having nearly 100 times the fatality rate of U.S. workers overall. A survey was designed to study pilot and company practices and attitudes in order to develop intervention strategies that would reduce aviation fatalities. METHODS: Two surveys were administered: one of air carrier operators and one of active commercial pilots. Surveys from 153 air taxi and public-use operators were received at a 79% response rate. RESULTS: There are almost 2000 pilots employed in Alaska during peak season by air taxi operators and public agencies. Surveyed operators and pilots generally agreed that improved weather information and regional hazards training would be effective ways to prevent crashes. Operators were more in favor of operator financial incentives (p < 0.05) and better pre-employment hiring checks on pilots (p < 0.05) compared with pilots' survey responses. There were 48% of pilots of large operators and 73% of pilots of small operators who considered their jobs to be at least as safe as other jobs. CONCLUSIONS: The results of operator-pilot comparisons suggest that financial pressures on operators may influence their views on what measures would be effective in preventing crashes, and that Alaskan pilots underestimate their occupational fatality risk.     

Submersion cases: a retrospective study--1988-1990.

According to the studied material the majority of the bodies found submersed in water (in the area covered by this report) were predominantly those of Caucasian males between 20 and 40 years of age, probably sober and without drug consumption when they entered the water. The majority of the cases were recovered from the water in the late spring and early summer and many of them were in different stages of decomposition which made the diagnosis of drowning impossible. The diagnosis of the cause and manner of death in such cases requires a complex interpretation of all investigative evidence and a logical approach in each case in particular.     

Urolithiasis in a children's hospital: 1985-1990.

We performed a retrospective study of patients who had urinary tract stones and were seen at our hospital from 1985-1990. The study was intended to determine the prevalence of urolithiasis and optimal approaches to imaging. Clinical data and imaging studies of 87 patients were reviewed. The mean age was 15.7 years with a range of 3 months to 44 years. Fifty-four percent of patients were male. Most patients had a known predisposing cause for urolithiasis; patients with myelodysplasia and structural urologic problems predominated. Plain films were performed in 77 patients; 57% showed stones. Ultrasonograms were performed in 71 patients; 77% showed stones. Excretory urograms (EU) were performed in 49 patients; 84% showed either stones or their effect on the urinary tract. Computed tomographic (CT) scan was performed in 25 patients; all showed stones.     

Appropriate imaging utilization in Japan: a survey of accredited radiology training hospitals

Purpose

To survey whether imaging is being performed appropriately in Japan, and to survey whether radiologists intervene to ensure imaging requests are appropriate.

Methods

An online survey was sent to radiologists at accredited radiology training hospitals. The survey included the radiologists’ perspectives on whether imaging is performed appropriately at their institutions and whether they intervene if the indication for imaging is inappropriate/ambiguous.

Results

The response rate was 87.3% (165/189). We observed marked variability in the frequencies that imaging not recommended by the guidelines was performed among modalities and/or body parts; the responses “very frequently/frequently performed” were more common for breast cancer related imaging examinations and for head CT/MRI. The respondents frequently reported that inappropriate/ambiguous indications included requests to expand the craniocaudal range or to perform whole-body imaging. In 80% of the hospitals (132/165), radiologists contacted the physicians who requested unrecommended examinations; the number of CT and MRI examinations that full-time radiologists need to interpret in a half-day session was significantly smaller at these hospitals (median 18 vs 24, P = 0.032).

Conclusion

We conducted a survey to investigate appropriate imaging utilization in Japan. At the hospitals with numerous examinations to interpret, full-time radiologists may find it difficult to ensure that examinations are ordered appropriately.