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Overnight attending radiologist coverage decreases imaging-related emergency department recalls by at least 90%



Benefits of overnight attending radiologist final reports are debated, often stating low resident discrepancy rates, usually assessed retrospectively. The objective of this study was to assess the impact of overnight final reporting on the recall rates for patients in the emergency department (ED) receiving overnight imaging.


Retrospective matched cohorts of two separate years prior (prior-16 and prior-17) and 1 year after (post-18) introduction of overnight attending radiologist final reporting. Patients receiving imaging between 22:00 and 07:00 h and returned to ED within 48 h of initial visit discharge were electronically identified. String matching identified return visits possibly related to imaging completed on first visit. Identified return visit notes were scored by three observers individually. Unclear and discrepant cases were resolved by consensus meeting, using full patient charts where needed. Incidences were provided and logistic regression analysis defined if coverage model was a predictor for recall. Odds ratios were calculated.


ED patient count with imaging completed overnight in prior-16 was 9200, in prior-17 was 9543, and in post-18 was 9992. The number of overnight imaging studies performed was respectively 13,883, 14,463, and 15,112. Imaging-related ED recalls were respectively 54, 61, and 7, a decrease with the new coverage model of 89% to true and at least 90% of expected recalls.Logistic regression demonstrated that coverage model was a significant predictor of ED recalls with chi-square of 59.86 and p < 0.001, an R2 of 0.03 (Hosmer and Lemeshow). Compared to post-18, ED patients had an odds ratio of 8.42 (prior-16) and 9.18 (prior-17) to be called back to ED.


Overnight final reporting significantly decreases ED recalls for patients receiving diagnostic imaging overnight. While numbers are low even prior to rollout, the number should be minimized wherever possible to diminish patient anxiety and discomfort, reduce ED overcrowding and expedite definitive management.

Key messages/what this paper adds

Section 1: What is already known on this subject

• Radiology resident preliminary report discrepancy rates are low.

• Overnight attending radiologist coverage is a model increasingly applied in academic and large non-academic centers.

• Patient recalls to the ED are a burden to the patient and impact patient throughput in (over)crowded EDs.

Section 2: What this study adds

• First study to look at the impact of overnight attending final reports on the recall rate for ED patients with overnight imaging performed.

• While absolute numbers are low, there is a significant decrease in patients returning to ED for imaging related issues after introducing overnight attending coverage.

• Resident autonomy can be preserved and training enhanced while increasing patient safety and comfort

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Correspondence to Ferco H. Berger.

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Research ethics review was not required because the study met criteria for exemption from such a review based on our institutional process for confirming that the project was deemed improvement in quality and not human subject research.

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Mughli, R.A., Durrant, E., Baia Medeiros, D.T. et al. Overnight attending radiologist coverage decreases imaging-related emergency department recalls by at least 90%. Emerg Radiol 28, 549–555 (2021).

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  • Imaging
  • Quality improvement
  • Emergency department management
  • Crowding
  • Recalls