- Email: [email protected]
Quantification of clinical consultations in academic emergency radiology1
Point/Counterpoint
Quantification of Clinical Consultations in Academic Emergency Radiology1 Salvatore Viscomi, MD, Kirstin M. Shu MD, MBA, Elise M. Blinder, John D. MacKenzie, MD, Stephen Ledbetter, MD, Frank J. Rybicki, MD, PhD
Rationale and Objectives. The purpose of this study is to quantify the impact of clinical consultation on the workload of an academic emergency radiology section. Materials and Methods. Data from a 7-day audit (24 h/d) of the number and length of clinical consultations was expressed as the mean number of consultations per 24 hours and consultation minutes per 24 hours. Consultations performed on images acquired from outside institutions were noted. The attending radiologist consultation fraction was defined as the attending consultation minutes per 24 hours divided by the number of minutes of attending coverage per 24 hours. Using annualized work relative value units per full-time employee (wRVU/FTE) over the 7 days, the consultation value unit per full-time employee (CVU/FTE) was defined and calculated as the consultation fraction multiplied by the annual wRVU/FTE. Results. For the attending radiologists, the consultation fraction was 0.13 and the CVU/FTE was 1216. Twenty-two percent of the total consultation minutes were spent on studies performed outside our institution. Conclusions. Clinical consultation represents a significant portion of the workload in academic emergency radiology. The consultation fraction describes the fraction of the radiologist’s time spent in consultation, and the CVU/FTE expresses the workload of clinical consultations in terms of wRVU/FTE, the factor used most commonly to determine the academic radiologist’s productivity and staffing. Key Words. Clinical consultation; emergency radiology; work relative value per full-time equivalent. ©
AUR, 2004
Clinical consultations are a critical component of radiology service, allowing for the communication of important imaging findings and enabling the radiologist to participate in a dialogue regarding patient management. In the academic radiology environment, clinical consultations also contribute largely to the education of trainees and can broadly be separated into (1) organized case conferences and (2) informal consultations performed shortly after the radiologist renders an impression. This project Acad Radiol 2004; 11:1294 –1297 1 From the Department of Radiology, Brigham and Women’s Hospital, 75 Francis Street, Boston, MA 02115 (S.V., K.M.S., E.M.B., J.D.M., S.L., F.J.R.). Received June 16, 2004; revision requested July 22; revision received July 31; revision accepted August 3. Address correspondence to F.J.R. e-mail: [email protected]
© AUR, 2004 doi:10.1016/j.acra.2004.07.024
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focuses on the later, informal clinical consultations in an emergency radiology section within a large, urban academic radiology department. Emergency radiology sections are relatively new in comparison to other sections in academic radiology (eg, thoracic radiology, musculoskeletal radiology); the patient population is organized according to the need for urgent treatment as opposed to the majority of imaging sections that are organized either by organ system or by imaging modality. However, with respect to the assessment of workload and productivity, academic emergency radiology sections are typically measured using the same scale as all sections in academic radiology, the work relative value unit per full-time equivalent (wRVU/FTE). Although it was not designed to measure workload or productivity, the wRVU/FTE has assumed this role (1),
Academic Radiology, Vol 11, No 11, November 2004
despite its broad variability (2) and the fact that “the use of wRVU/FTE for comparing clinical workloads across subspecialties has major shortcomings” (3). Nevertheless, the wRVU/FTE is typically used to determine staffing levels and to compare the clinical productivity among sections in academic radiology. Adjustment factors have been proposed; to date these adjustments have focused on the fact that services with a large proportion of CT and MR will generate more wRVU/FTE than services that interpret fewer CT and MR studies (4). Because of the organization of an emergency radiology section, clinical consultations comprise a significant proportion of the workload. A study addressing unscheduled consultations throughout a University Hospital with 20 staff radiologists found that on average, each radiologist spent 21.65 minutes in clinical consultation (5) per day. The purpose of the present study is to assess the impact of clinical consultation in an emergency radiology section. In addition to auditing minutes in clinical consultation, this study reports two parameters derived from those minutes. The first is the “consultation fraction” which represents the number of consultation minutes divided by the number of minutes that the radiologist spends on the clinical service. The purpose of the consultation fraction is to determine that fraction of the radiologist’s time in clinical consultation. The second parameter is termed the consultation value unit per full time equivalent (CVU/ FTE). This parameter is the consultation fraction scaled by the section’s wRVU/FTE. Because the CVU/FTE is derived in the units of wRVU/FTE, it represents a measure of workload spent in clinical consultation that can be used in conjunction with the wRVU/FTE.
MATERIALS AND METHODS The staffing in the division of emergency radiology at our institution is as follows: attending coverage every day from 8:00 AM–11:00 PM (900 min/24 h), and continuous resident coverage. The attending coverage is divided into 2 shifts (8:00 AM– 4:00 PM, 4:00 PM–11:00 PM), resulting in 14 shifts/week. One FTE works 4 shifts per week (averaged over a year), so that the emergency radiology division has 3.5 FTE (14 shifts/wk divided by 4 shifts/FTE). From 11:00 PM– 8:00 AM, the resident assumes responsibility for all radiology studies in the hospital and consults on all studies for which there is a specific request. As an additional task, the resident performs clinical consultation for all inpatient studies performed at our institution be-
QUANTIFICATION OF CLINICAL CONSULTATIONS
tween the hours of 8:00 PM and 8:00 AM. The emergency radiology attending interprets all exams requested from Emergency Medicine with the exception of MRI; the MR images are interpreted by the other sections in the department, organized by organ systems. The emergency radiology section is located physically within the Department of Emergency Medicine, and because of the proximity of the radiologist to the Emergency Medicine physicians, virtually all clinical consultations are performed in person. All studies performed at our institution are interpreted via picture archival and communication system (PACS). However, since our institution serves as a Level 1 trauma center, patients are frequently transferred with “hard copy” images that generate clinical consultations. Over a 7-day period (24 h/d) in the division of emergency radiology at our institution, each clinical consultation was recorded by the radiologist (attending or resident) by completing a consultation form that included the following information: day of the week, time of day (7:00 AM– 4:00 PM, 4:00 PM–11:00 PM, 11:00 PM–7:00 AM), level of clinician requesting consultation (attending vs. resident or nonMD, eg, nurse practitioner), radiologist performing consultation (attending vs. resident), and length of consultation (⬍1 minute, 1–5 minutes, 5–10 minutes, ⬎10 minutes). For the purposes of totaling the consultation minutes, all consultations ⬍1 minute were considered 0.5 minutes, 1–5 minutes considered 3 minutes, and 5–10 minutes considered 7.5 minutes. For consultations greater than 10 minutes, the actual number of minutes was documented and tallied. If multiple consultations were request on an individual set of images, each consultation was counted separately. As an example, consider a trauma CT of the head, entire cervical spine, chest, abdomen, and pelvis. If there is a lengthy consultation with the senior surgical resident on the trauma service, this would be tallied as 1 consult for ⬎10 minutes, and the number of minutes would be documented. If this consult is followed several minutes later with an 8-minute discussion and review of the images with the trauma attending surgeon, it would be tallied as 1 consult, 5–10 minutes. If, during the next emergency radiology shift, a portion of the cervical spine CT were reviewed for 2 minutes with the surgical intensive care senior resident, a third consult (1–5 minutes) would be tallied. The clinical consultation form completed for each consultation also included the following information regarding the images: type of study (radiographs, ultrasound, CT, MRI), and institution where images performed (our institution vs. outside study). For images performed at our
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institution, the number of clinical consultations performed for studies outside of Emergency Medicine (ie, inpatient studies) was documented. Over the same 7 days, the wRVUs for the division were documented. The annualized wRVU/FTE was computed as the number of wRVUs over the week multiplied by 52 weeks per year, and then divided by 3.5 FTEs for our section. The adjusted wRVU/FTEs were computed by weighting only the wRVUs from CT and MRI by 0.58 (4). For both the attendings and the residents, the consultation minutes were tallied. The daily consultation fraction was defined to represent the fraction of working minutes per day during which the radiologist performed consultation. The attending consultation fraction ⫽ staff consultation minutes/900 minutes staff coverage, and the resident consultation fraction ⫽ resident consultation minutes/1440 minutes resident coverage. For the attendings, the CVU/ FTE was defined as the consultation fraction multiplied by the annualized wRVU/FTE before and after the adjustment. As a measure of quality control for the audit, over 5 1-hour periods where “traffic” in the Emergency Radiology reading area is typically highest, an external audit of clinical consultations was performed (in addition to and unknown by the attending and resident radiologists). The external auditor collected data identical to that obtained by the radiologists, except for the fact that the exact number of consultation minutes was measured and documented with a stopwatch as opposed to categorizing the length of consultation (⬍1 minute, 1–5 minutes, 5–10 minutes, ⬎10 minutes). The number of consultations and consultation minutes obtained by the external auditor was compared to that obtained by the radiologists during the same time periods.
RESULTS Over the 7-day period, 2023.5 radiologist minutes were spent in a total of 425 clinical consultations. Eighty-one percent of the consultations were requested by trainees and nonMDs; 19% were requested by staff. Fifty-eight percent of consultation minutes were performed by radiology residents; 42% were performed by attending radiologists. The distribution of clinical consultations and total number of consultation minutes with respect to day of the week (number of consultations/number of minutes) was Sunday 46/299.5, Monday 72/266.5, Tuesday 62/384.5, Wednesday 61/287.5,
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Table Average Number of Clinical Consults and Consultation Minutes per 24 Hours*
Attending
Attending and Resident
Number of clinical consults/24 h 26 61 Consultation mins/24 h 121 min 289 min Consultation fraction 0.13 (121/900) 0.20 (289/1440) *The consultation minutes per 24 hours is used to compute the consultation fraction.
Thursday 66/297.5, Friday 53/262, Saturday 65/226. The consultation fraction was 0.13 for the radiology attendings and 0.20 for the residents (Table). Over the week of the audit, the number of emergency radiology wRVUs was 629.3 and the annualized wRVU/FTE ⫽ 9350 (629.3 RVU/week ⫻ 52 weeks/3.5 FTE). The staff CVU/FTE was 1216 (0.13 CF ⫻ 9350 RVU/FTE). Using the adjustment factor that weights the CT and MR scans by a factor of 0.58, the number of wRVUs was 469.1, leading to an annualized wRVU/ FTE ⫽ 6969 and a staff CVU/FTE of 906. The distribution of consultation minutes with respect to institution where the image was performed was 47% from our institution’s Emergency Medicine department, 31% inpatient studies from our institution, and 22% outside studies. Fifty two percent of consultation minutes were spent on radiography, 44% CT, 3% ultrasound, and 1% MRI. The external audit of clinical consultations showed that the radiologists underestimated the number of consultations and consultation minutes by less than 3% and 6%, respectively.
CONCLUSIONS Thirteen percent of the attending radiologist’s time was spent in clinical consultation, demonstrating the impact of clinical consultation on the emergency radiology workload. Compared to data in the literature, specifically that the average radiologist spends 21.65 minutes in consultation (5), the time spent in emergency radiology clinical consultation is approximately five times that spent in a radiology department as a whole. However, at present, comparing data between institutions must be done with caution since the overall workloads of each, and the details regarding the types of exams performed are not available. One potential limitation of this study is that neither of the new parameters (the consultation fraction and
Academic Radiology, Vol 11, No 11, November 2004
the CVU/FTE) have a benchmark in academic radiology. However, both are simply derived from the actual number of minutes spent in clinical consultation, and both can be computed for any section. Moreover, because the CVU/FTE is scaled according to the wRVU/ FTE, it should, along with the consultation fraction, prove useful in comparing clinical consultations between sections within an academic radiology department. The CVU/FTE can be used to adjust the wRVU/ FTE as a measure of workload and thus can aid in determining appropriate staffing levels. A large-scale audit of consultation minutes across our department, including our community radiology sections, is currently being planned. Twenty-two percent of the total consultation minutes were for studies performed at outside hospitals, reflecting the fact that our institution serves as a referral center for trauma patients. In dedicated oncologic radiology, second opinion consultations have been shown to increase the average daily work volume (computed with respect to the number of studies) by 18% (6). Considering only those studies performed at outside hospitals, the emergency radiology workload increase, measured in terms of minutes, is approximately 3% (22% of the 0.13 consultation fraction). This value is strongly dependent of the number of trauma patients transferred to Emergency Medicine and the severity of the injuries. Typically, second opinion trauma consultations are lengthy because hard copy images are used instead of PACS (7).
QUANTIFICATION OF CLINICAL CONSULTATIONS
Although imperfect, the wRVU/FTE will likely remain the metric used to assess the productivity of the emergency radiologist. Because clinical consultations in academic emergency radiology compromise a significant proportion of the workload, the time in consultation should be considered in measuring productivity and determining staffing levels. Consultations can be measured in absolute minutes, or via parameters such as the consultation fraction and the CVU/FTE. These parameters can also be used to determine the impact of clinical consultations on the workload of other sections in an academic radiology department. REFERENCES 1. Cortegiano MJ. Academic radiologist productivity: a national benchmark, 1998. Radiol Business Managers Assoc Bull 1999; 34:4 –12 2. Sunshine JH, Burkhardt JH. Radiology groups’ workload in relative value units and factors affecting it. Radiology 2000; 214:815– 822 3. Arenson RL, Lu Y, Elliott SC, Jovais C, Avrin DE. Measuring the academic radiologist’s clinical productivity: survey results for subspecialty sections. Acad Radiol 2001; 8:524 –532 4. Arenson RL, Lu Y, Elliott SC, Jovais C, Avrin DE. Measuring the academic radiologist’s clinical productivity: applying RVU adjustment factors. Acad Radiol 2001; 8:533–540 5. Dalla Palma L, Stacul F, Meduri S, Geitung JTE. Relationships between radiologists and clinicians: results from three surveys. Clin Radiol 2000; 55:602– 605 6. DiPiro PJ, vanSonnenberg E, Tumeh SS, Ros PR. Volume and impact of second-opinion consultations by radiologists at a tertiary care cancer center: data. Acad Radiol 2002; 9:1430 –1433 7. Reiner B, Siegel E, Protopapas Z, Hooper F, Ghebrekidan H, Scanlon M. Impact of filmless radiology on frequency of clinician consultation with radiologists. AJR Am J Roentgenol 1999; 173:1173–1174
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Quantification of Clinical Consultations in Academic Emergency Radiology1 Salvatore Viscomi, MD, Kirstin M. Shu MD, MBA, Elise M. Blinder, John D. MacKenzie, MD, Stephen Ledbetter, MD, Frank J. Rybicki, MD, PhD
Rationale and Objectives. The purpose of this study is to quantify the impact of clinical consultation on the workload of an academic emergency radiology section. Materials and Methods. Data from a 7-day audit (24 h/d) of the number and length of clinical consultations was expressed as the mean number of consultations per 24 hours and consultation minutes per 24 hours. Consultations performed on images acquired from outside institutions were noted. The attending radiologist consultation fraction was defined as the attending consultation minutes per 24 hours divided by the number of minutes of attending coverage per 24 hours. Using annualized work relative value units per full-time employee (wRVU/FTE) over the 7 days, the consultation value unit per full-time employee (CVU/FTE) was defined and calculated as the consultation fraction multiplied by the annual wRVU/FTE. Results. For the attending radiologists, the consultation fraction was 0.13 and the CVU/FTE was 1216. Twenty-two percent of the total consultation minutes were spent on studies performed outside our institution. Conclusions. Clinical consultation represents a significant portion of the workload in academic emergency radiology. The consultation fraction describes the fraction of the radiologist’s time spent in consultation, and the CVU/FTE expresses the workload of clinical consultations in terms of wRVU/FTE, the factor used most commonly to determine the academic radiologist’s productivity and staffing. Key Words. Clinical consultation; emergency radiology; work relative value per full-time equivalent. ©
AUR, 2004
Clinical consultations are a critical component of radiology service, allowing for the communication of important imaging findings and enabling the radiologist to participate in a dialogue regarding patient management. In the academic radiology environment, clinical consultations also contribute largely to the education of trainees and can broadly be separated into (1) organized case conferences and (2) informal consultations performed shortly after the radiologist renders an impression. This project Acad Radiol 2004; 11:1294 –1297 1 From the Department of Radiology, Brigham and Women’s Hospital, 75 Francis Street, Boston, MA 02115 (S.V., K.M.S., E.M.B., J.D.M., S.L., F.J.R.). Received June 16, 2004; revision requested July 22; revision received July 31; revision accepted August 3. Address correspondence to F.J.R. e-mail: [email protected]
© AUR, 2004 doi:10.1016/j.acra.2004.07.024
1294
focuses on the later, informal clinical consultations in an emergency radiology section within a large, urban academic radiology department. Emergency radiology sections are relatively new in comparison to other sections in academic radiology (eg, thoracic radiology, musculoskeletal radiology); the patient population is organized according to the need for urgent treatment as opposed to the majority of imaging sections that are organized either by organ system or by imaging modality. However, with respect to the assessment of workload and productivity, academic emergency radiology sections are typically measured using the same scale as all sections in academic radiology, the work relative value unit per full-time equivalent (wRVU/FTE). Although it was not designed to measure workload or productivity, the wRVU/FTE has assumed this role (1),
Academic Radiology, Vol 11, No 11, November 2004
despite its broad variability (2) and the fact that “the use of wRVU/FTE for comparing clinical workloads across subspecialties has major shortcomings” (3). Nevertheless, the wRVU/FTE is typically used to determine staffing levels and to compare the clinical productivity among sections in academic radiology. Adjustment factors have been proposed; to date these adjustments have focused on the fact that services with a large proportion of CT and MR will generate more wRVU/FTE than services that interpret fewer CT and MR studies (4). Because of the organization of an emergency radiology section, clinical consultations comprise a significant proportion of the workload. A study addressing unscheduled consultations throughout a University Hospital with 20 staff radiologists found that on average, each radiologist spent 21.65 minutes in clinical consultation (5) per day. The purpose of the present study is to assess the impact of clinical consultation in an emergency radiology section. In addition to auditing minutes in clinical consultation, this study reports two parameters derived from those minutes. The first is the “consultation fraction” which represents the number of consultation minutes divided by the number of minutes that the radiologist spends on the clinical service. The purpose of the consultation fraction is to determine that fraction of the radiologist’s time in clinical consultation. The second parameter is termed the consultation value unit per full time equivalent (CVU/ FTE). This parameter is the consultation fraction scaled by the section’s wRVU/FTE. Because the CVU/FTE is derived in the units of wRVU/FTE, it represents a measure of workload spent in clinical consultation that can be used in conjunction with the wRVU/FTE.
MATERIALS AND METHODS The staffing in the division of emergency radiology at our institution is as follows: attending coverage every day from 8:00 AM–11:00 PM (900 min/24 h), and continuous resident coverage. The attending coverage is divided into 2 shifts (8:00 AM– 4:00 PM, 4:00 PM–11:00 PM), resulting in 14 shifts/week. One FTE works 4 shifts per week (averaged over a year), so that the emergency radiology division has 3.5 FTE (14 shifts/wk divided by 4 shifts/FTE). From 11:00 PM– 8:00 AM, the resident assumes responsibility for all radiology studies in the hospital and consults on all studies for which there is a specific request. As an additional task, the resident performs clinical consultation for all inpatient studies performed at our institution be-
QUANTIFICATION OF CLINICAL CONSULTATIONS
tween the hours of 8:00 PM and 8:00 AM. The emergency radiology attending interprets all exams requested from Emergency Medicine with the exception of MRI; the MR images are interpreted by the other sections in the department, organized by organ systems. The emergency radiology section is located physically within the Department of Emergency Medicine, and because of the proximity of the radiologist to the Emergency Medicine physicians, virtually all clinical consultations are performed in person. All studies performed at our institution are interpreted via picture archival and communication system (PACS). However, since our institution serves as a Level 1 trauma center, patients are frequently transferred with “hard copy” images that generate clinical consultations. Over a 7-day period (24 h/d) in the division of emergency radiology at our institution, each clinical consultation was recorded by the radiologist (attending or resident) by completing a consultation form that included the following information: day of the week, time of day (7:00 AM– 4:00 PM, 4:00 PM–11:00 PM, 11:00 PM–7:00 AM), level of clinician requesting consultation (attending vs. resident or nonMD, eg, nurse practitioner), radiologist performing consultation (attending vs. resident), and length of consultation (⬍1 minute, 1–5 minutes, 5–10 minutes, ⬎10 minutes). For the purposes of totaling the consultation minutes, all consultations ⬍1 minute were considered 0.5 minutes, 1–5 minutes considered 3 minutes, and 5–10 minutes considered 7.5 minutes. For consultations greater than 10 minutes, the actual number of minutes was documented and tallied. If multiple consultations were request on an individual set of images, each consultation was counted separately. As an example, consider a trauma CT of the head, entire cervical spine, chest, abdomen, and pelvis. If there is a lengthy consultation with the senior surgical resident on the trauma service, this would be tallied as 1 consult for ⬎10 minutes, and the number of minutes would be documented. If this consult is followed several minutes later with an 8-minute discussion and review of the images with the trauma attending surgeon, it would be tallied as 1 consult, 5–10 minutes. If, during the next emergency radiology shift, a portion of the cervical spine CT were reviewed for 2 minutes with the surgical intensive care senior resident, a third consult (1–5 minutes) would be tallied. The clinical consultation form completed for each consultation also included the following information regarding the images: type of study (radiographs, ultrasound, CT, MRI), and institution where images performed (our institution vs. outside study). For images performed at our
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institution, the number of clinical consultations performed for studies outside of Emergency Medicine (ie, inpatient studies) was documented. Over the same 7 days, the wRVUs for the division were documented. The annualized wRVU/FTE was computed as the number of wRVUs over the week multiplied by 52 weeks per year, and then divided by 3.5 FTEs for our section. The adjusted wRVU/FTEs were computed by weighting only the wRVUs from CT and MRI by 0.58 (4). For both the attendings and the residents, the consultation minutes were tallied. The daily consultation fraction was defined to represent the fraction of working minutes per day during which the radiologist performed consultation. The attending consultation fraction ⫽ staff consultation minutes/900 minutes staff coverage, and the resident consultation fraction ⫽ resident consultation minutes/1440 minutes resident coverage. For the attendings, the CVU/ FTE was defined as the consultation fraction multiplied by the annualized wRVU/FTE before and after the adjustment. As a measure of quality control for the audit, over 5 1-hour periods where “traffic” in the Emergency Radiology reading area is typically highest, an external audit of clinical consultations was performed (in addition to and unknown by the attending and resident radiologists). The external auditor collected data identical to that obtained by the radiologists, except for the fact that the exact number of consultation minutes was measured and documented with a stopwatch as opposed to categorizing the length of consultation (⬍1 minute, 1–5 minutes, 5–10 minutes, ⬎10 minutes). The number of consultations and consultation minutes obtained by the external auditor was compared to that obtained by the radiologists during the same time periods.
RESULTS Over the 7-day period, 2023.5 radiologist minutes were spent in a total of 425 clinical consultations. Eighty-one percent of the consultations were requested by trainees and nonMDs; 19% were requested by staff. Fifty-eight percent of consultation minutes were performed by radiology residents; 42% were performed by attending radiologists. The distribution of clinical consultations and total number of consultation minutes with respect to day of the week (number of consultations/number of minutes) was Sunday 46/299.5, Monday 72/266.5, Tuesday 62/384.5, Wednesday 61/287.5,
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Table Average Number of Clinical Consults and Consultation Minutes per 24 Hours*
Attending
Attending and Resident
Number of clinical consults/24 h 26 61 Consultation mins/24 h 121 min 289 min Consultation fraction 0.13 (121/900) 0.20 (289/1440) *The consultation minutes per 24 hours is used to compute the consultation fraction.
Thursday 66/297.5, Friday 53/262, Saturday 65/226. The consultation fraction was 0.13 for the radiology attendings and 0.20 for the residents (Table). Over the week of the audit, the number of emergency radiology wRVUs was 629.3 and the annualized wRVU/FTE ⫽ 9350 (629.3 RVU/week ⫻ 52 weeks/3.5 FTE). The staff CVU/FTE was 1216 (0.13 CF ⫻ 9350 RVU/FTE). Using the adjustment factor that weights the CT and MR scans by a factor of 0.58, the number of wRVUs was 469.1, leading to an annualized wRVU/ FTE ⫽ 6969 and a staff CVU/FTE of 906. The distribution of consultation minutes with respect to institution where the image was performed was 47% from our institution’s Emergency Medicine department, 31% inpatient studies from our institution, and 22% outside studies. Fifty two percent of consultation minutes were spent on radiography, 44% CT, 3% ultrasound, and 1% MRI. The external audit of clinical consultations showed that the radiologists underestimated the number of consultations and consultation minutes by less than 3% and 6%, respectively.
CONCLUSIONS Thirteen percent of the attending radiologist’s time was spent in clinical consultation, demonstrating the impact of clinical consultation on the emergency radiology workload. Compared to data in the literature, specifically that the average radiologist spends 21.65 minutes in consultation (5), the time spent in emergency radiology clinical consultation is approximately five times that spent in a radiology department as a whole. However, at present, comparing data between institutions must be done with caution since the overall workloads of each, and the details regarding the types of exams performed are not available. One potential limitation of this study is that neither of the new parameters (the consultation fraction and
Academic Radiology, Vol 11, No 11, November 2004
the CVU/FTE) have a benchmark in academic radiology. However, both are simply derived from the actual number of minutes spent in clinical consultation, and both can be computed for any section. Moreover, because the CVU/FTE is scaled according to the wRVU/ FTE, it should, along with the consultation fraction, prove useful in comparing clinical consultations between sections within an academic radiology department. The CVU/FTE can be used to adjust the wRVU/ FTE as a measure of workload and thus can aid in determining appropriate staffing levels. A large-scale audit of consultation minutes across our department, including our community radiology sections, is currently being planned. Twenty-two percent of the total consultation minutes were for studies performed at outside hospitals, reflecting the fact that our institution serves as a referral center for trauma patients. In dedicated oncologic radiology, second opinion consultations have been shown to increase the average daily work volume (computed with respect to the number of studies) by 18% (6). Considering only those studies performed at outside hospitals, the emergency radiology workload increase, measured in terms of minutes, is approximately 3% (22% of the 0.13 consultation fraction). This value is strongly dependent of the number of trauma patients transferred to Emergency Medicine and the severity of the injuries. Typically, second opinion trauma consultations are lengthy because hard copy images are used instead of PACS (7).
QUANTIFICATION OF CLINICAL CONSULTATIONS
Although imperfect, the wRVU/FTE will likely remain the metric used to assess the productivity of the emergency radiologist. Because clinical consultations in academic emergency radiology compromise a significant proportion of the workload, the time in consultation should be considered in measuring productivity and determining staffing levels. Consultations can be measured in absolute minutes, or via parameters such as the consultation fraction and the CVU/FTE. These parameters can also be used to determine the impact of clinical consultations on the workload of other sections in an academic radiology department. REFERENCES 1. Cortegiano MJ. Academic radiologist productivity: a national benchmark, 1998. Radiol Business Managers Assoc Bull 1999; 34:4 –12 2. Sunshine JH, Burkhardt JH. Radiology groups’ workload in relative value units and factors affecting it. Radiology 2000; 214:815– 822 3. Arenson RL, Lu Y, Elliott SC, Jovais C, Avrin DE. Measuring the academic radiologist’s clinical productivity: survey results for subspecialty sections. Acad Radiol 2001; 8:524 –532 4. Arenson RL, Lu Y, Elliott SC, Jovais C, Avrin DE. Measuring the academic radiologist’s clinical productivity: applying RVU adjustment factors. Acad Radiol 2001; 8:533–540 5. Dalla Palma L, Stacul F, Meduri S, Geitung JTE. Relationships between radiologists and clinicians: results from three surveys. Clin Radiol 2000; 55:602– 605 6. DiPiro PJ, vanSonnenberg E, Tumeh SS, Ros PR. Volume and impact of second-opinion consultations by radiologists at a tertiary care cancer center: data. Acad Radiol 2002; 9:1430 –1433 7. Reiner B, Siegel E, Protopapas Z, Hooper F, Ghebrekidan H, Scanlon M. Impact of filmless radiology on frequency of clinician consultation with radiologists. AJR Am J Roentgenol 1999; 173:1173–1174
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