•
•
Education
Emergency Room Radiology: A Format for Instructing House Staff 1 Morton Schneider, M.D., Sidney Ulrelch, M.D., 2 and Lucy Frank Squire, M.D. Seminars covering the use of radiographic studies in the emergency room were given to the house staff. Greater efficiency in ordering indicated studies was achieved, and fewer repeat studies and unnecessary radiographic examinations were ordered. In addition, the radiologist and his staff became more aware of clinical problems in the emergency room. The authors feel that a series of seminars of this type can have a beneficial effect on general patient care. INDEX TERMS:
Education. Radiology and Radiologists
Radiology 116: 73-74, July 1975
•
• Since the emergency room staff rotated monthly, the seminars were repeated each month. Requirements for ordering particular studies were emphasized, particularly obtaining a pertinent history and physical examination for each patient before requesting the appropriate films. We brought out simple facts such as the inadequacy of a routine chest film for evaluating rib fractures, the fact that a skull series and a facial series are not the same, and even such elementary points as the difference between a foot examination and an ankle examination. Film cases were presented informally but with increasing difficulty of material, and additional cases were shown as.unknowns. Each case was presented with the appropriate history and physical examination; most were actual patients from the emergency room. The study group was encouraged to decide specifically whether the radiograph under discussion was necessary, whether the proper film had been ordered, whether any additional films should have been ordered, and whether a diagnosis could be reached from the film obtained. The radiologist then reviewed each film with the group, indicated the importance and limitations of the various examinations illustrated, and covered further investigations which might be performed better within the radiology department itself, either presently or at some future date. The seminars were not presented in a didactic form but kept informal to allow for discussion in putting together the material. We strongly emphasized the need for giving the essential history and physical findings on the x-ray request. Additional emphasis was placed on what information one could expect from the various radiographs ordered, and frequent consultations with the radiologist were recommended. Throughout each of the seminars, the role of the radiologist assigned to the
NUMBERS of nonemergency patients are being handled by the emergency rooms of large urban hospitals. This has led to a tremendous increase in the number of radiographic examinations performed and necessitated long delays, particularly when repeat examinations or additional views are necessary. Delay caused by taking the wrong films or incomplete examinaton may be disastrous in the critically ill patient. Unnecessary studies are being requested by health professionals who have little radiological background, such as residents, interns, medical students, nurses, and paramedical personnel, particularly foreign medical graduates serving on the house staff of large city hospitals, who frequently are not aware of the limitations and values of the various radiographic views and often use radiographic examinations as a screening procedure to help deal with the large number of patients. Although these health professionals have analyzed the patient's problems, there is a lack of communication between them and the radiology department. We have established a radiological instruction program in our emergency room for all medical and paramedical personnel in an attempt to solve some of these problems.
R
ISING
MATERIALS AND METHODS
Eight seminars were given at a convenient time, usually early in the morning and for not more than 30 minutes. We began with an orientation about the radiology department, the role of the radiologist, and the reasons for trying to improve communications between the primary-care physicians and their staff and the radiologist and his staff. Two seminars were then devoted to emergency examination of the extremities, two to the chest, one to the abdomen, and two to the head and spine.
1 From the Department of Radiology, Downstate Medical Center-Kings County Hospital, Brooklyn, N. Y. Presented at the Sixtieth Scientific Assembly and Annual Meeting of the Radiological Society of North America, Chicago, III., Dec. 1-6, 1974. 2 Present address: Department of Diagnostic Radiology, Yale University School of Medicine, 333 Cedar St., New Haven, Conn. 06510. sjh
73
74
MORTON SCHNEIDER AND OTHERS
emergency room was reiterated. It was emphasized that he was not there just to read films from behind closed doors but should be consulted regularly, at times even before the films are ordered. Better communication with the radiology department should result in better patient care. RESULTS AND OBSERVATIONS
The initial results were very encouraging: efficiency in ordering films increased and the need for repeat examinations decreased. The increase in the number of consultations with the radiologist in the emergency room was the most striking change. Because of this improved rapport, the radiologist often recommended further follow-up studies and indicated whether they should be done on an emergency basis or could be delayed, thus exerting greater control over movement of patients. In addition, the interns and medical students became aware of the teachlnq program and looked forward to their tour of duty in the emergency room.
July 1975
CONCLUSIONS
Our series of seminars has had a beneficial effect on general patient care. The emergency room house staff has become more familiar with conventional radiographic views, and there is a better appreciation of the value of a particular examination as well as its limitations. In addition, while the house staff was learning about radiological problems, the radiologist and his staff have become more aware of clinical problems in the emergency room. The radiologist has begun to assume greater control over the way emergency patients are being examined radiographically, and we believe that ultimately the results should be more efficient handling of emergency cases.
Department of Radiology Downstate Medical Center 450 Clarkson Ave. Brooklyn, N. Y. 11203
•
Education
Emergency Room Radiology: A Format for Instructing House Staff 1 Morton Schneider, M.D., Sidney Ulrelch, M.D., 2 and Lucy Frank Squire, M.D. Seminars covering the use of radiographic studies in the emergency room were given to the house staff. Greater efficiency in ordering indicated studies was achieved, and fewer repeat studies and unnecessary radiographic examinations were ordered. In addition, the radiologist and his staff became more aware of clinical problems in the emergency room. The authors feel that a series of seminars of this type can have a beneficial effect on general patient care. INDEX TERMS:
Education. Radiology and Radiologists
Radiology 116: 73-74, July 1975
•
• Since the emergency room staff rotated monthly, the seminars were repeated each month. Requirements for ordering particular studies were emphasized, particularly obtaining a pertinent history and physical examination for each patient before requesting the appropriate films. We brought out simple facts such as the inadequacy of a routine chest film for evaluating rib fractures, the fact that a skull series and a facial series are not the same, and even such elementary points as the difference between a foot examination and an ankle examination. Film cases were presented informally but with increasing difficulty of material, and additional cases were shown as.unknowns. Each case was presented with the appropriate history and physical examination; most were actual patients from the emergency room. The study group was encouraged to decide specifically whether the radiograph under discussion was necessary, whether the proper film had been ordered, whether any additional films should have been ordered, and whether a diagnosis could be reached from the film obtained. The radiologist then reviewed each film with the group, indicated the importance and limitations of the various examinations illustrated, and covered further investigations which might be performed better within the radiology department itself, either presently or at some future date. The seminars were not presented in a didactic form but kept informal to allow for discussion in putting together the material. We strongly emphasized the need for giving the essential history and physical findings on the x-ray request. Additional emphasis was placed on what information one could expect from the various radiographs ordered, and frequent consultations with the radiologist were recommended. Throughout each of the seminars, the role of the radiologist assigned to the
NUMBERS of nonemergency patients are being handled by the emergency rooms of large urban hospitals. This has led to a tremendous increase in the number of radiographic examinations performed and necessitated long delays, particularly when repeat examinations or additional views are necessary. Delay caused by taking the wrong films or incomplete examinaton may be disastrous in the critically ill patient. Unnecessary studies are being requested by health professionals who have little radiological background, such as residents, interns, medical students, nurses, and paramedical personnel, particularly foreign medical graduates serving on the house staff of large city hospitals, who frequently are not aware of the limitations and values of the various radiographic views and often use radiographic examinations as a screening procedure to help deal with the large number of patients. Although these health professionals have analyzed the patient's problems, there is a lack of communication between them and the radiology department. We have established a radiological instruction program in our emergency room for all medical and paramedical personnel in an attempt to solve some of these problems.
R
ISING
MATERIALS AND METHODS
Eight seminars were given at a convenient time, usually early in the morning and for not more than 30 minutes. We began with an orientation about the radiology department, the role of the radiologist, and the reasons for trying to improve communications between the primary-care physicians and their staff and the radiologist and his staff. Two seminars were then devoted to emergency examination of the extremities, two to the chest, one to the abdomen, and two to the head and spine.
1 From the Department of Radiology, Downstate Medical Center-Kings County Hospital, Brooklyn, N. Y. Presented at the Sixtieth Scientific Assembly and Annual Meeting of the Radiological Society of North America, Chicago, III., Dec. 1-6, 1974. 2 Present address: Department of Diagnostic Radiology, Yale University School of Medicine, 333 Cedar St., New Haven, Conn. 06510. sjh
73
74
MORTON SCHNEIDER AND OTHERS
emergency room was reiterated. It was emphasized that he was not there just to read films from behind closed doors but should be consulted regularly, at times even before the films are ordered. Better communication with the radiology department should result in better patient care. RESULTS AND OBSERVATIONS
The initial results were very encouraging: efficiency in ordering films increased and the need for repeat examinations decreased. The increase in the number of consultations with the radiologist in the emergency room was the most striking change. Because of this improved rapport, the radiologist often recommended further follow-up studies and indicated whether they should be done on an emergency basis or could be delayed, thus exerting greater control over movement of patients. In addition, the interns and medical students became aware of the teachlnq program and looked forward to their tour of duty in the emergency room.
July 1975
CONCLUSIONS
Our series of seminars has had a beneficial effect on general patient care. The emergency room house staff has become more familiar with conventional radiographic views, and there is a better appreciation of the value of a particular examination as well as its limitations. In addition, while the house staff was learning about radiological problems, the radiologist and his staff have become more aware of clinical problems in the emergency room. The radiologist has begun to assume greater control over the way emergency patients are being examined radiographically, and we believe that ultimately the results should be more efficient handling of emergency cases.
Department of Radiology Downstate Medical Center 450 Clarkson Ave. Brooklyn, N. Y. 11203
