Radiologist, trainee, and logistical factors impacting the timeliness of CTA head and neck reporting in stroke code activations

BACKGROUND AND PURPOSE: Timely reporting of CTA exams impacts management of acute vascular pathology such as large vessel occlusions, arterial dissection, and ruptured aneurysm as well as a variety of acute non-vascular pathologies. In this study, we examine potential modifiable factors impacting the timeliness of CTA reporting performed in stroke code activations.

MATERIALS AND METHODS: Observational study of stroke code CTA head and neck exams performed at a single health system (3 emergency departments, 1550 inpatient beds) over four years (1/1/2019-12/31/2023). 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: 8422 stroke code CTA exams were performed. Median TAT was 29 minutes (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 lower patient age, emergency department setting, time later in the academic year, non-business 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<0.05). 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 -2.6 to +43.3 minutes) and trainees (-49.6 to +109.0 minutes); reporting CTAs without a trainee and release of preliminary reports prior to final sign were associated with faster TATs (-11.4 and -24.7 minutes, respectively). Each stroke CTA within the preceding hour was associated with only a 4.0-minute increase in TAT. Secondary analyses suggested that previewing of cases during active scanning and use of “structured” reports correlates with favorable impact on TAT among attending radiologists (both p<0.05).

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.

ABBREVIATIONS: IQR, interquartile range; TAT, turnaround time; TFR, time to final report.