Radiologist, Trainee, and Logistical Factors Impacting the Timeliness of CTA Head and Neck Reporting in Stroke Code Activations.

Abstract

Background and purpose: Timely reporting of CTA examinations impacts management of acute vascular pathology such as large vessel occlusions, arterial dissection, and ruptured aneurysms, as well as a variety of acute nonvascular pathologies. In this study, we examine potential modifiable factors impacting the timeliness of CTA reporting performed in stroke code activations.

Materials and methods: This is an observational study of stroke code CTA head and neck examinations performed at a single health system (3 emergency departments, 1550 inpatient beds) during 4 years (January 1, 2019, to December 31, 2023). Patient age, patient sex, care setting, time of year, shift type, trainee/attending radiologist characteristics, report factors, and number of CTAs performed within the preceding hour were considered potential factors impacting the turnaround time (TAT) of stroke code CTAs. Descriptive statistics, univariate regression, and multivariate regression were used to estimate the impact on reporting TAT.

Results: We performed 8422 stroke code CTA examinations. Median TAT was 29 minutes (interquartile range [IQR] 18-48). Median TAT by individual attending radiologists varied from 15 to 40 minutes (median of medians, 29 minutes [IQR 26-34.5]). Univariate regression analyses found younger patient age, emergency department setting, time later in the academic year, nonbusiness hours, specific individual radiologists/trainees, solo reporting by attending radiologists, use of preliminary reports, and fewer stroke codes within the preceding hour to all be associated with shorter TATs (all P < .05). After adjusting for patient-, logistical-, and radiologist-level factors in a multivariate regression model, the greatest impact on TAT was seen with variation in individual attending radiologists (adjusted coefficients, -11.9 to +29.4 minutes) and trainees (-40.1 to +95.7 minutes); reporting CTAs without a trainee and release of preliminary reports before final sign were associated with faster TATs (-19.9 and -26.9 minutes, respectively). Each stroke CTA within the preceding hour was associated with only a 2.8-minute increase in TAT. Secondary analyses suggested that previewing of cases during active scanning and use of "structured" reports correlate with a favorable impact on TAT among attending radiologists (both P < .05).

Conclusions: Radiologist and trainee-level timeliness in stroke CTA reporting varies widely. Interventions aimed at improving workflow efficiency for both trainees and attending radiologists could improve timeliness of reporting.