Acknowledgment

This work is supported by the John S. Dunn Research Foundation.

Purpose

Introduction

Principles

1.  Imaging management of all patients seen in the Memorial Hermann Hospital Emergency Center (EC) is the responsibility of the section of emergency radiology, including assigned residents, fellows, and faculty.
    All imaging studies, including U/S and CT, with the sole exception of neuro CT and non-trauma abdominal CT, shall be reported by Emergency Radiology faculty.

2.  Emergency Radiology is a “hands-on” radiologic subspecialty that requires constant radiologist supervision.

3.  It is the responsibility of the radiologist (resident, fellow, faculty) to assure that all conventional radiographic examinations are performed in a timely fashion (as dictated by patient condition), are of the standard number and type of projections per Section policy, and are of diagnostic quality.

4.  All computed tomographic (CT) examinations are performed only with prior approval by the radiologist, except in extreme circumstances.

5.  Ideally, all patients referred to Emergency Radiology should have a succinct, concise history and physical examination pertinent to the chief complaint.  The purpose is to ascertain that the appropriate radiographic examination has been requested.  When the radiologist believes a different, or additional, study is appropriate, the radiologist must consult the attending physician.  For example, the routine shoulder examination is not the appropriate study for the scapula; different and specific views are required for the wrist and the hand; anatomically and radiographically, the ankle, heel and foot are distinctly separate, though related, areas and each requires specific and different projections.

6.  The radiologist, and radiologic technologist, are part of the Memorial Hermann Hospital “Trauma Team.”  Both the radiologist and radiologic technologist must respond promptly to a Code 3 and be in the Trauma Center prior to patient arrival.

7.  In conformance with the guidelines for the characterization of Level 1 hospital emergency capabilities published by the Commission on Emergency Medical Services of the American Medical Association (December, 1989), staff radiologists shall be promptly available and be on call for consultation and on-site supervision of radiologic procedures performed on patients in the Emergency Department.

Policies – General

1.  The morning faculty “check-out” shall begin @ 0700 hours unless otherwise designated by the emergency room attending physician.  All residents assigned to Emergency Radiology are expected to be in attendance.

2.  The night-call resident must complete dictation as efficiently as possible to allow the clerk to remove completed cases and hang new cases.

3.  The day time resident(s) must continually monitor film accumulation at the clerk’s desk and, through clerk encouragement, assure prompt hanging of new cases.

4.  When not actively involved in radiologic patient care, the resident(s) should pre-read cases in preparation for “check-out.”  The resident is expected to present a brief history of the case (as provided by the attending or through personal observation), describe the abnormal findings, and justify a diagnosis or reasonable differential diagnosis based upon the findings.

5.  Radiology residents are strongly encouraged to take advantage of any “free” time to (1) become familiar with radiologic technology by assisting the technologists, (2) become familiar with film processing and the “dark-room,” and (3) take advantage of the rather extensive library provided in the Reading Room.

6.  When leaving the Emergecy Center, the resident(s) must tell the senior technologist where the resident will be and assure the technologist has the resident’s pager number.  When called, the resident must respond promptly.

7.  As a member of the Trauma Team, it is essential and entirely appropriate, that the radiologist enter the Trauma Room to become visually familiar with the patient’s condition, hear the results of the assessment of the patient by the senior surgical resident, assist the radiologic technologist as needed, and to provide prompt interpretations as the radiographs become available.  The interpretation must be made verbally to the senior surgical resident in such manner as is necessary to assure the interpretation has been heard. This is best accomplished on a face-to-face basis.  DO NOT RELY ON ANYONE ELSE TO CORRECTLY CONVEY YOUR INTERPRETATION.

8.  All first year radiology resident interpretations must be supervised by a radiology fellow or attending.