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type=\u0022text\/css\u0022 rel=\u0022stylesheet\u0022 href=\u0022\/\/d282kpwvnogo5m.cloudfront.net\/sites\/default\/files\/advagg_css\/css__ce2QY63WIanKyr8eSq7eavr1XQRRmFD6ZSmwpyJi8lM__zXwFqpqmxrZOXXcd_TpBQpjuELbmIP9wBR5UuTDWAO4__YJWWMMdfCJuAFm5cUEp88OsodhO3ZA-2lzRfoBsSlk4.css\u0022 media=\u0022all\u0022 \/\u003E\n\u003Clink rel=\u0027stylesheet\u0027 type=\u0027text\/css\u0027 href=\u0027\/sites\/all\/modules\/contrib\/panels\/plugins\/layouts\/onecol\/onecol.css\u0027 \/\u003E\u003C\/head\u003E\u003Cbody\u003E\u003Cdiv class=\u0022panels-ajax-tab-panel panels-ajax-tab-panel-sageoa-tab-art\u0022\u003E\u003Cdiv class=\u0022panel-display panel-1col clearfix\u0022 \u003E\n  \u003Cdiv class=\u0022panel-panel panel-col\u0022\u003E\n    \u003Cdiv\u003E\u003Cdiv class=\u0022panel-pane pane-highwire-markup\u0022 \u003E\n  \n      \n  \n  \u003Cdiv class=\u0022pane-content\u0022\u003E\n    \u003Cdiv class=\u0022highwire-markup\u0022\u003E\u003Cdiv xmlns=\u0022http:\/\/www.w3.org\/1999\/xhtml\u0022 id=\u0022content-block-markup\u0022 xmlns:xhtml=\u0022http:\/\/www.w3.org\/1999\/xhtml\u0022\u003E\u003Cdiv class=\u0022article fulltext-view \u0022\u003E\u003Cspan class=\u0022highwire-journal-article-marker-start\u0022\u003E\u003C\/span\u003E\u003Cdiv class=\u0022section abstract\u0022 id=\u0022abstract-1\u0022\u003E\u003Ch2\u003ESummary\u003C\/h2\u003E\n            \u003Cp id=\u0022p-1\u0022\u003EThere is increasing demand for round-the-clock radiology coverage in academic medical centers, which poses a range of challenges. In this session, presenters reviewed the issues of staffing including scheduling and staff retention, clinical coverage, resident autonomy and training, financial considerations, and balancing clinical needs with academic demands.\u003C\/p\u003E\n         \u003C\/div\u003E\u003Cul class=\u0022kwd-group\u0022\u003E\u003Cli class=\u0022kwd\u0022\u003Etrauma\u003C\/li\u003E\u003Cli class=\u0022kwd\u0022\u003Eemergency radiology\u003C\/li\u003E\u003C\/ul\u003E\u003Cdiv class=\u0022section\u0022 id=\u0022sec-1\u0022\u003E\n         \n         \u003Cp id=\u0022p-2\u0022\u003EThere is increasing demand for round-the-clock radiology coverage in academic medical centers, which poses a range of challenges. In this session, presenters reviewed the issues of staffing including scheduling and staff retention, clinical coverage, resident autonomy and training, financial considerations, and balancing clinical needs with academic demands.\u003C\/p\u003E\n      \u003C\/div\u003E\u003Cdiv class=\u0022section\u0022 id=\u0022sec-2\u0022\u003E\n         \u003Ch2 class=\u0022\u0022\u003EER RADIOLOGY COVERAGE WITH A TELERADIOLOGY BUSINESS\u003C\/h2\u003E\n         \u003Cp id=\u0022p-3\u0022\u003EAaron Sodickson, MD, PhD, Brigham and Women\u0027s Hospital (BWH), Boston, Massachusetts, USA, discussed a coverage model in which a teleradiology business is used to support expanded 24\/7 radiology coverage at a tertiary, academic, level 1 trauma center.\u003C\/p\u003E\n         \u003Cp id=\u0022p-4\u0022\u003EThe emergency radiology section at BWH provides coverage to the emergency department (ED) and multiple other regional hospitals and urgent care centers. Shifts have been added over the years to include round-the-clock attending coverage, with an overlap shift during the busiest period.\u003C\/p\u003E\n         \u003Cp id=\u0022p-5\u0022\u003EThe expansion of coverage was made possible by the teleradiology business, which provided increased work volume and revenues to support the hiring of additional attending radiologists at BWH, while also enhancing care at surrounding facilities and strengthening the regional reputation of BWH. However, the teleradiology business adds complexity to the workflow, a need for more information technology support, and new business challenges associated with program administration and customer service. In addition, competition within the mature teleradiology market has resulted in downward price pressures, imparting risk of relying on this source of revenues to maintain 24\/7 coverage at BWH itself.\u003C\/p\u003E\n         \u003Cp id=\u0022p-6\u0022\u003EDr Sodickson presented 3 staffing models to achieve 24\/7 coverage, including the option initially used at BWH in which there are separate day and night crews (\u003Ca id=\u0022xref-table-wrap-1-1\u0022 class=\u0022xref-table\u0022 href=\u0022#T1\u0022\u003ETable 1\u003C\/a\u003E). He commented that he would consider a second model, in which all staff members work all shifts, if he were setting up a new program from the beginning. The third model is a hybrid of the first two.\u003C\/p\u003E\n         \u003Cdiv id=\u0022T1\u0022 class=\u0022table pos-float\u0022\u003E\u003Cdiv class=\u0022table-inline\u0022\u003E\u003Cdiv class=\u0022callout\u0022\u003E\u003Cspan\u003EView this table:\u003C\/span\u003E\u003Cul class=\u0022callout-links\u0022\u003E\u003Cli class=\u00220 first\u0022\u003E\u003Ca href=\u0022\/\u0022 class=\u0022table-expand-inline\u0022 data-table-url=\u0022\/highwire\/markup\/16496\/expansion?postprocessors=highwire_figures%2Chighwire_math%2Chighwire_inline_linked_media%2Chighwire_embed\u0026amp;table-expand-inline=1\u0022 html=\u00221\u0022 fragment=\u0022#\u0022 external=\u00221\u0022 data-icon-position=\u0022\u0022 data-hide-link-title=\u00220\u0022\u003EView inline\u003C\/a\u003E\u003C\/li\u003E\u003Cli class=\u00221\u0022\u003E\u003Ca href=\u0022\/highwire\/markup\/16496\/expansion?width=1000\u0026amp;height=500\u0026amp;iframe=true\u0026amp;postprocessors=highwire_figures%2Chighwire_math%2Chighwire_inline_linked_media\u0022 class=\u0022colorbox colorbox-load table-expand-popup\u0022 rel=\u0022gallery-fragment-tables\u0022 data-icon-position=\u0022\u0022 data-hide-link-title=\u00220\u0022\u003EView popup\u003C\/a\u003E\u003C\/li\u003E\u003Cli class=\u00222 last\u0022\u003E\u003Ca href=\u0022\/highwire\/powerpoint\/16496\u0022 class=\u0022highwire-figure-link highwire-figure-link-ppt\u0022 data-icon-position=\u0022\u0022 data-hide-link-title=\u00220\u0022\u003EDownload powerpoint\u003C\/a\u003E\u003C\/li\u003E\u003C\/ul\u003E\u003C\/div\u003E\u003C\/div\u003E\u003Cdiv class=\u0022table-caption\u0022\u003E\u003Cspan class=\u0022table-label\u0022\u003ETable 1.\u003C\/span\u003E \n               \u003Cp id=\u0022p-7\u0022 class=\u0022first-child\u0022\u003EModels of 24\/7 Coverage\u003C\/p\u003E\n            \u003Cdiv class=\u0022sb-div caption-clear\u0022\u003E\u003C\/div\u003E\u003C\/div\u003E\u003C\/div\u003E\n         \u003Cp id=\u0022p-8\u0022\u003EDr Sodickson also addressed issues of scheduling and compensation. For those working purely overnight shifts, he recommended a 1-in-3 model, with 3 radiologists who cover all nights between them. A 1-in-2 model is not considered sustainable. Because night work must be compensated with time or money, BWH uses an increasing hourly differential compensation rate from daytime hours (8 am to 4 pm), to evening hours (4 pm to midnight), and overnight hours (midnight to 8 am). To support the academic mission, Dr Sodickson encourages use of a hybrid staffing model instead of pure night work. He emphasizes that if academic productivity is expected, it is crucial to hire highly motivated staff, provide sufficient academic time with adequate recovery time after night shifts, and suggest that an academic incentive plan may be helpful to recognize academic effort.\u003C\/p\u003E\n      \u003C\/div\u003E\u003Cdiv class=\u0022section\u0022 id=\u0022sec-3\u0022\u003E\n         \u003Ch2 class=\u0022\u0022\u003EOVERNIGHT RADIOLOGY COVERAGE\u003C\/h2\u003E\n         \u003Cp id=\u0022p-9\u0022\u003ENext, Lovleen Kaur Cavanagh, DO, North Shore-Long Island Jewish Health Systems, Manhasset, New York, USA, explained the overnight model used by the North Shore-Long Island Jewish Emergency Radiology Section. They have 12 emergency radiologists who work nights and have radiologists with training in neuroradiology, body imaging, and musculoskeletal imaging; 6 (4 emergency radiologists and 2 residents) work as a team each night. Their current coverage model consists of a cycle of 1 week of work followed by 2 weeks off, for a total of 17 weeks worked each year plus additional bridge shifts. Shifts are 9 and 12 hours for weekdays and weekends, respectively, with staggered coverage during the busiest times.\u003C\/p\u003E\n         \u003Cp id=\u0022p-10\u0022\u003EUsing dedicated on-site reading rooms, the emergency radiologists read all ED and inpatient community hospital cross-sectional imaging (not plain radiographs); they also do preliminary reads on tertiary inpatient imaging. Subspecialists in neuroimaging, body imaging, and musculoskeletal imaging divide up the reading according to their specialties. This results in an overall load of approximately 60 and 90 cross-sectional reads per ED radiologist for weekdays and weekends, respectively.\u003C\/p\u003E\n         \u003Cp id=\u0022p-11\u0022\u003EThe work is divided up so that 2 ED radiologists at the main campus tertiary hospitals supervise residents, 2 radiologists are assigned to read cases and handle phone calls for the 7 community hospitals in the system, and a teleradiology group is used if there is an overload or other problem. The residents at the tertiary hospitals read cases under supervision and handle phone calls, but their preliminary reports are not sent out. During the middle shift (5 to 9 pm), subspecialists in neuroimaging and body imaging are available at the tertiary hospitals in a staggered shift until 8:30 pm while emergency radiologists arrive at 8:30 pm.\u003C\/p\u003E\n         \u003Cp id=\u0022p-12\u0022\u003ETo accomplish academic work, the radiologists have to be motivated to work on their weeks off. However, all members are involved in academics. For example, they supervise residents, participate in conferences, and teach medical students. With the addition of a new chair and vice chair of research, they plan to increase research and build the academics over the next few years.\u003C\/p\u003E\n         \u003Cp id=\u0022p-13\u0022\u003EDr Cavanagh concluded by summarizing advantages and challenges of night work. Benefits include compensation, good workflow, and interesting cases. Challenges include building a sustainable model, handling tight turnaround times, and meeting demands of heavy shifts while balancing home and family responsibilities.\u003C\/p\u003E\n      \u003C\/div\u003E\u003Cdiv class=\u0022section\u0022 id=\u0022sec-4\u0022\u003E\n         \u003Ch2 class=\u0022\u0022\u003E24\/7 SUBSPECIALTY COVERAGE USING A HYBRID MODEL\u003C\/h2\u003E\n         \u003Cp id=\u0022p-14\u0022\u003EFinally, Syed A. Jamal Bokhari, MBBS, Yale University School of Medicine, New Haven, Connecticut, USA, discussed ways to move to 24\/7 subspecialty coverage using a hybrid model while focusing on staffing models and on the academic mission. There is increased demand for imaging in EDs [Levin DC et al. \u003Cem\u003EJ Am Coll Radiol.\u003C\/em\u003E 2014], combined with pressure for short stays and rapid treatment. Additionally, much of the need for imaging occurs after regular business hours or on weekends; there is a morning peak as imaging may be needed in preparation for morning discharges. Changes in the work done by residents and needs of hospitalists to work throughout the day also affect imaging needs. Even electronic medical records are driving this trend, as clinicians do not want patients to see preliminary reports; it is important to be careful regarding what is in the electronic medical records.\u003C\/p\u003E\n         \u003Cp id=\u0022p-15\u0022\u003EAs the model at Yale has changed, reliance on generalists and specialists has changed. There is a hybrid model of generalists, subspecialists, and teleradiologists available remotely. Generalists are attending physicians who usually work in a different specialty but sometimes cover the emergency room (ER) or a fellow working in the ER. Non-ER subspecialists provide coverage in areas such as body imaging, pediatrics, musculoskeletal systems, ultrasound, neuroimaging, and nuclear medicine. Emergency radiology subspecialists have fellowship training in the ER and work there predominantly. On weekdays, weekends, and holidays, Yale has subspecialists available and 1 to 2 attending physicians in the ER (\u003Ca id=\u0022xref-table-wrap-2-1\u0022 class=\u0022xref-table\u0022 href=\u0022#T2\u0022\u003ETable 2\u003C\/a\u003E).\u003C\/p\u003E\n         \u003Cdiv id=\u0022T2\u0022 class=\u0022table pos-float\u0022\u003E\u003Cdiv class=\u0022table-inline\u0022\u003E\u003Cdiv class=\u0022callout\u0022\u003E\u003Cspan\u003EView this table:\u003C\/span\u003E\u003Cul class=\u0022callout-links\u0022\u003E\u003Cli class=\u00220 first\u0022\u003E\u003Ca href=\u0022\/\u0022 class=\u0022table-expand-inline\u0022 data-table-url=\u0022\/highwire\/markup\/16497\/expansion?postprocessors=highwire_figures%2Chighwire_math%2Chighwire_inline_linked_media%2Chighwire_embed\u0026amp;table-expand-inline=1\u0022 html=\u00221\u0022 fragment=\u0022#\u0022 external=\u00221\u0022 data-icon-position=\u0022\u0022 data-hide-link-title=\u00220\u0022\u003EView inline\u003C\/a\u003E\u003C\/li\u003E\u003Cli class=\u00221\u0022\u003E\u003Ca href=\u0022\/highwire\/markup\/16497\/expansion?width=1000\u0026amp;height=500\u0026amp;iframe=true\u0026amp;postprocessors=highwire_figures%2Chighwire_math%2Chighwire_inline_linked_media\u0022 class=\u0022colorbox colorbox-load table-expand-popup\u0022 rel=\u0022gallery-fragment-tables\u0022 data-icon-position=\u0022\u0022 data-hide-link-title=\u00220\u0022\u003EView popup\u003C\/a\u003E\u003C\/li\u003E\u003Cli class=\u00222 last\u0022\u003E\u003Ca href=\u0022\/highwire\/powerpoint\/16497\u0022 class=\u0022highwire-figure-link highwire-figure-link-ppt\u0022 data-icon-position=\u0022\u0022 data-hide-link-title=\u00220\u0022\u003EDownload powerpoint\u003C\/a\u003E\u003C\/li\u003E\u003C\/ul\u003E\u003C\/div\u003E\u003C\/div\u003E\u003Cdiv class=\u0022table-caption\u0022\u003E\u003Cspan class=\u0022table-label\u0022\u003ETable 2.\u003C\/span\u003E \n               \u003Cp id=\u0022p-16\u0022 class=\u0022first-child\u0022\u003ECoverage at Yale Medical Center\u003C\/p\u003E\n            \u003Cdiv class=\u0022sb-div caption-clear\u0022\u003E\u003C\/div\u003E\u003C\/div\u003E\u003C\/div\u003E\n         \u003Cp id=\u0022p-17\u0022\u003EDr Bokhari concluded by addressing the implications of these changes for the academic mission. Reduced need for fellows reduces their workload but also limits their ability to supplement their salaries. It is important to consider ways to increase autonomy for residents [Collins et al. \u003Cem\u003EAcad Radiol.\u003C\/em\u003E 2014], to involve residents in as many cases as possible, and to create teaching opportunities for residents. By using creativity and thoughtful planning of educational opportunities, it is possible to maintain the academic mission.\u003C\/p\u003E\n      \u003C\/div\u003E\u003Cul class=\u0022copyright-statement\u0022\u003E\u003Cli class=\u0022fn\u0022 id=\u0022copyright-statement-1\u0022\u003E\u00a9 2015 MD Conference Express\u00ae\u003C\/li\u003E\u003C\/ul\u003E\u003Cspan class=\u0022highwire-journal-article-marker-end\u0022\u003E\u003C\/span\u003E\u003C\/div\u003E\u003Cspan id=\u0022related-urls\u0022\u003E\u003C\/span\u003E\u003C\/div\u003E\u003Ca href=\u0022http:\/\/mdc.sagepub.com\/content\/14\/53\/6.abstract\u0022 class=\u0022hw-link hw-link-article-abstract\u0022 data-icon-position=\u0022\u0022 data-hide-link-title=\u00220\u0022\u003EView Summary\u003C\/a\u003E\u003C\/div\u003E  \u003C\/div\u003E\n\n  \n  \u003C\/div\u003E\n\u003C\/div\u003E\n  \u003C\/div\u003E\n\u003C\/div\u003E\n\u003C\/div\u003E\u003Cscript type=\u0022text\/javascript\u0022 src=\u0022http:\/\/mdc.sagepub.com\/sites\/all\/modules\/highwire\/highwire\/plugins\/highwire_markup_process\/js\/highwire_openurl.js?nzls81\u0022\u003E\u003C\/script\u003E\n\u003Cscript type=\u0022text\/javascript\u0022 src=\u0022http:\/\/mdc.sagepub.com\/sites\/all\/modules\/highwire\/highwire\/plugins\/highwire_markup_process\/js\/highwire_tables.js?nzls81\u0022\u003E\u003C\/script\u003E\n\u003C\/body\u003E\u003C\/html\u003E"}