with adenotonsillar hyperplasia and in o n e asthmatic child. EKG abnormalities were seen in 3 cases. C o n c l u s i o n : Midazolam premedication followed by IV pentobarbital sedation administered p e r AAP guidelines to children undergoing MRI permitted p r o m p t and safe sedation, expedited discharge and minimized emotional stress to child, family and medical personnel. T a k e H o m e P o i n t s : Same as Conclusion.
4-19 Radiologists' Management of a Radiology Department-Two Year's Experience Bruce J. Hillman,MD, University of Virginia HSC, Charlottesville, VA, Bennett A. Alford, MD, StacyD. Crowell P u r p o s e : In 1994, our Dept. of Radiology contracted with the Medical Center to manage the technical aspects of its radiologic practice, including personnel and operations. The Department receives a managem e n t fee and an incentive based on m o n e y saved. W e evaluated the impact of this program on cost and quality. M e t h o d s : To manage the program, t h e Department developed a pointof-service m a n a g e m e n t structure. We established both Departmentwide and area specific standards for cost and quality performance and measured regularly for adherence. Incentives were paid to the Departm e n t based on inflation-adjusted savings vs. a base year, FY '94. Results: Over the t w o years of the program, t h e Medical Center saved more than $3 million on an annual budget of $15 million. Focused projects related to timeliness of service and "client" satisfaction demonstrated i m p r o v e m e n t s in quality. C o n c l u s i o n s : Radiologists' m a n a g e m e n t of the technical aspects of delivering imaging services aligns incentives b e t w e e n physicians and their hospital and can reduce cost while maintaining or improving quality. T a k e H o m e P o i n t s : Combined technical-professional m a n a g e m e n t of radiology departments can reduce cost and improve quality; contracting b e t w e e n hospital and physician can align incentives and improve relationships.
4- 21 Early Impact of Managed Care in Diagnostic Radiology Training Rodolfo Queiroz,MD, University of Rochester Medical Center, Rochester, NY, RaymondK. Tan, MD, John Reiser,MD, Arvin E. Robinson, MD P u r p o s e : To evaluate t h e early impact of the rapidly changing health care environment in diagnostic radiology residency training. M a t e r i a l s a n d M e t h o d s : A questionnaire was mailed in November 1996 to 175 chief residents in diagnostic radiology w h o s e n a m e s were obtained from the database of t h e American Association of Academic Chief Residents in Radiology. W e surveyed t h e status of u n m a t c h e d resident positions over the last three years, changes in resident selection criteria, plans in reducing residency positions, n u m b e r and quality of residency applicants and general changes in workload, teaching time, staffing resource and call responsibilities at their institutions. Results: Preliminary results reveal disturbing trends. Many positions have been filled outside the traditional matching system. The n u m b e r and quality of applicants has decreased, and m a n y programs are voluntarily decreasing the n u m b e r of positions offered. Downsizing of faculty and changes in call responsibilities have affected teaching time and increased work load. C o n c l u s i o n : Preliminary n u m b e r s indicate significant and alarming changes in diagnostic radiology resident selection and training. Results from the complete assessment will be provided at the time of the meeting. T a k e H o m e P o i n t s : 1. The continuous trend towards a m a n a g e d care market has already substantially influenced the p r o c e s s of selection and training of diagnostic radiology residents. 2. Many diagnostic radi° ology programs are filling their o p e n positions outside t h e traditional matching selection process.
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4- 22 Radiology Department Management by Radiologists Robert L. Siegle,MD, University of Texas HSC, San Antonio, TX, Lenn Nelsen,MS P u r p o s e : Radiologists have rarely had direct administrative control of the hospital departments in w h i c h they practice, except in the military and VA. Even in a university hospital setting, department employees and faculty rarely are part of the same table of organization until the level of medical center CEO is reached. T w o years ago the administrations of the medical school at t h e University of Texas Health Science Center at San Antonio and its county-owned, principal teaching hospital agreed to integrate the physician and adininistration managem e n t of the radiology department in an attempt to improve operations and reduce expenses. This integration is a pilot plan that will eventually be extended to all departments. M a t e r i a l s a n d M e t h o d s : We have collected statistics that measure department f u n c t i o n fortlae first year of physician m a n a g e m e n t and compared these statistics with those of t h e previous twelve m o n t h s prior to physician management. Results: Results include significant increases in departtnent activity and billing while reducing e x p e n s e s and waiting times for procedures. These changes have occurred while overall hospital activity has decreased. C o n c l u s i o n : Radiologists can have a significant impact on departm e n t operations w h e n given the responsibility and authority for managing these affairs. T a k e H o m e P o i n t s : • Radiologists can be effective department managers • Hospitals can benefit from contracting with radiologists to manage their departments.
4- 23 Use of Prior Radiographic Reports Wilbur L. Smith, Jr, MD, University of Iowa Hospitals & Clinics, Iowa City, IA, KevinS. Berbaum,PhD P u r p o s e : This study d o c u m e n t e d the useful age of reports of prior radiographic (RPR) studies and the types of information derived from RPR during radiograph interpretation. M a t e r i a l s a n d M e t h o d s : Prospective interpretations of 209 radiographic examinations in w h i c h the radiologist used RPR were studied. The type of study, age of old radiology reports, and the information sought from the RPR were recorded. Results: The oldest report employed is best described using t h e median of the distribution, this figure being 211 days for all types of studies. The median age of RPR for cross sectional imaging was 110 days, 53 days for nuclear medicine studies, 334 days for plain films, 39 days for ultrasound, and 22 days for interventional studi£.~s.The patterns of use were similar for all readings, a cluster in age pfRPR used followed by an exponential decline of use. Reports less than one year of age were used for 64% of interpretations and reports two years of age or less sufficed for 86% of all interpretations. RPR were judged most valuable in providing clinical history mad for comparison with the previous radiologist's interpretation. C o n c l u s i o n s : RPR are c o m m o n l y accessed for u p to two years; thereafter, their use is sporadic, implying that slower access to RPR older than two years m a y be an acceptable choice. Most of the value of RPR was in comparing the current interpretation with that of the previous radiologist and in obtaining clinical history.
4-24 Survey of Chairmen of Departments in Radiology and Radiation Oncology Kent D. Nash,PhD, Radiological Society of North America, Oak Brook, IL, C. Douglas Maynard, MD, DanaA. Davis P u r p o s e : Survey of the chairmen of departments in radiology and radiation oiacology to determine the level of resources in and commitm e n t to radiological research. An examination is also m a d e of the types of funding m a d e by the RSNA Research and Education Fund.