New Clinical Program: Emergency Radiology at Zuckerberg San Francisco General Hospital

On July 1, 2022, UCSF and Zuckerberg San Francisco General Hospital (ZSFG) established a new Emergency Radiology section to provide after-hours faculty coverage for imaging exams conducted between 5 pm and midnight. With the leadership of Mark Wilson, MD, ZSFG Chief of Radiology, faculty members Jason Talbott, MD, PhD, Shital Gandhi, MBBS, and Amrutha Ramachandran, MBBS, staff this new endeavor along with 8 per-diem faculty.

Members of the new Emergency Radiology section at ZSFG. Left to right: Vinil Shah, MD, Margaret Damiano, MBA, Shital Gandhi, MD, Jason Talbott, MD, PhD; Mark Wilson, MDPrior to establishing this new section, on-call radiology residents reviewed and provided a preliminary interpretation of after-hours studies, with the attending radiologist doing a final read the following day. Our data show that historical next-day attending call-back rates were approximately 2.7% for patients discharged from the emergency department (or 1-2 exams per day). While the overall rate of call-backs was relatively low, this presented particular challenges for ZSFG's patient population, approximately 16% of whom do not have stable housing, which makes contact and follow-up care more difficult.

Between July and December 2022, faculty provided final reads for all ZSFG emergency department cross-sectional imaging studies (N = 5,000, approx) performed between 5pm and midnight. Comparing July – December 2021 with July - December 2022, this new model has reduced discrepant overreads by 55% for patients discharged from the emergency department. Comparing the same periods, the average turnaround time from wet read to final read dropped from 30 hours to just over 2 hours.

Preserving on-call resident autonomy and enhancing the resident learning experience are key elements of this new clinical program. On-call residents handle the protocol, interpretation and initial wet reads for more than 95% of imaging exams at ZSFG. This independent call system creates a great learning environment in San Francisco's only Level 1 trauma center, granting residents an autonomy that few other training programs provide. Our residents value this opportunity for independence, while the new Emergency Radiology section helps decrease the turnaround time for final interpretation of imaging studies.

In the program's first six months, we achieved 96% faculty coverage from 5 pm – midnight. Our goal for 2023 is to achieve 100% coverage for 5 pm – midnight, while maintaining our focus on improved patient outcomes and ensuring that the trainee experience remains autonomous and distinctive.