Jason Neil Itri MD, PhD, Presenter: Nothing to Disclose

Alexander T Ruutiainen MD, Abstract Co-Author: Nothing to Disclose

Mary Helene Scanlon MD, Abstract Co-Author: Nothing to Disclose

Despite the lack of empirical data on the impact of fatigue on resident performance, there has been strong public and governmental pressure to restrict resident work hours in an effort to reduce fatigue-related adverse events. We sought to evaluate the relationship between night float call shift length and resident major discrepancy rate in the interpretation of radiological studies on-call. The purpose of this study was to reduce resident major discrepancy rates by shortening night float call shift length from 12 hours to 10 hours.

We used a web-based software application (Orion) to track resident major discrepancy rates in preliminary interpretations by 2 hour blocks of 10 and 12 hour night float call shifts during 1 and 2-week shifts. A major discrepancy is a discrepancy between the resident preliminary interpretation and attending final interpretation that has the potential to impact patient management or outcome.

Review of major discrepancy rates (January to June 2010) for 12-hour weekday night float call shifts revealed a peak during the final 2 hour block (overall average 1.0%, last 2-hour block 1.8%). The major discrepancy rate was greatest for computed tomography (CT, overall average 2.2%, last 2-hour block 3.8%), with a similar trend. In July 2010, weekday night float call shifts were reduced to 10 hours. This resulted in a decrease in the overall major discrepancy rate from 1.0% to 0.5% without a peak during the final 2 hour block (July to December 2010). Moreover, the overall major discrepancy rate for CT decreased from 2.2% to 1.1%, with a modest peak during the final 2 hour block (1.7%).

Shortening the length of consecutive night float call shifts from 12 to 10 hours reduced overall radiology resident major discrepancy rate and the relative peak in major discrepancy rate during the final 2 hours of overnight call shifts. Improvement in major discrepancy rates was likely related to reducing the impact of fatigue.

Reduction of overnight call shift length from 12 to 10 hours can reduce the number of potentially significant major discrepancies in radiology resident preliminary interpretations provided on-call.

Itri, J, Ruutiainen, A, Scanlon, M, Reducing the Impact of Fatigue on Resident Major Discrepancy Rate by Shortening Overnight Call Shift Length.  Radiological Society of North America 2011 Scientific Assembly and Annual Meeting, November 26 - December 2, 2011 ,Chicago IL. http://archive.rsna.org/2011/11005555.html