Transition of Care - Radiology Residents

DEPT: RADIOLOGY EDUCATION
POLICY #: 8240.24

GOAL

To provide guidelines for effective transitions of care for radiology residents. 

POLICY

1. Transitions in direct patient care are relatively rare in the practice of radiology. Because the majority of radiologic practice involves image interpretation, direct patient care of a length requiring transition of care is generally limited to the setting of post-procedural observation (for example, monitoring of patients for pneumothorax following lung biopsy). In the majority of cases, the time of observation still is of a short length, and periods of observation usually do not span greater than a single shift.

However, the concept of transfer of care may also be applied to the transfer of patient information, a situation that applies more frequently than the situation above in radiologic practice. Pending scans or procedures are often discussed with referring clinical services, and important information regarding patient history conveyed. The transfer of this information at change of shift is important for proper protocoling of radiologic examinations, for informed interpretation of images obtained, and proper triaging and performance of imaging guided interventional procedures or fluoroscopic examinations.

Transitions of care are minimized in order to minimize miscommunications.

2. Transitions of care occur in the radiology department daily:

A) At the start of the day, the radiology resident completing an overnight call shift transitions care to the members of the department covering the various radiologic services for the workday.

i) The post call resident reviews the results of all imaging studies which he/she reviewed overnight with the assigned attending staff. At this time, results conveyed to referring clinical series and relevant clinical histories applying to each case are communicated with the attending staff. Following this discussion, the resident amends reports and places appropriate phone calls to referring clinical services in situations where the overnight interpretation of the exam and the final attending read differ. Appropriate voice clips are placed on the PACS system for each case before the post call resident leaves the hospital.

ii) The post call resident is also responsible for conveyance of information regarding upcoming procedures or imaging studies to the individual responsible for the relevant radiology service. This individual could include either a resident or an attending staff member.

iii) In the situation of a pending diagnostic examination(s), the radiology resident night float hands off any pertinent patient information communicated by the care team (i.e., ER, trauma team, stroke neurology) to the incoming morning reading room residents and/or staff radiologists at 7:30 AM. There is an overlap of 30 mins prior to the night float resident end of shift, so there is ample time for this transition of care to be accomplished.

B) At the end of the workday, radiology residents and staff covering individual services are responsible for communication of information to the resident and/or attending staff covering the evening shift.

C) At the end of the evening shift, the attending staff performing the shift is responsible for communication of information to the overnight call resident.

D) In the situation of an interventional radiology (IR) patient, the transition is directly with the IR attending at the end of the week/rotation by the radiology resident on the IR service on the final Friday.

3. Conveyance of information during transitions of care outlined above will be performed verbally, with review of any relevant imaging studies, at the time of change of shift. Important information includes:

A) Patient history of contrast allergy.

B) Clinical indications for upcoming studies which require specific tailoring of exams to be performed (for example, need for multiphasic CT of the liver in a patient with suspected hepatocellular carcinoma rather than the standard portal venous phase exam).

C) Patient history pertinent to tailored interpretation of exam findings.

D) Indications for and specific information pertinent to fluoroscopy examinations and imaging guided (interventional) procedures.

E) History regarding any patient undergoing active monitoring for post procedural complications following imaging guided procedures.

4. To ensure that residents are competent in communicating with team members in the hand-over process the program director or core faculty will observe and assess a handover for each resident and document the evaluation.

5. The program and clinical sites will maintain and communicate schedules of attending physicians and residents currently responsible for care.

6. The program maintains backup plans to ensure continuity of patient care in the event that a resident may be unable to perform their patient care responsibilities due to excessive fatigue or illness, or family emergency. See Resident Well-Being Policy for more information.

COTTAGE HEALTH POLICY

Original Policy Effective Date: 07/2011
Last Review Date: 1/2024
Last Revision Date: 1/2023
Owner Title: Program Director, Radiology Residency
Owner Approval Date: 1/2024
Committee Approval: Graduate Medical Education (GMEC)
Committee Approval Dates: 1/2024
VP Approval: CMO/VPMA
VP Approval Date: 1/2024