One of the many challenges facing emergency departments (EDs) across North America is timely access to emergency radiology services. Academic institutions, which are typically also regional referral centres, frequently require cross-sectional studies to be performed 24 hours a day with expedited final reports to accelerate patient care and ED flow.

The purpose of this study was to determine if the presence of an in-house radiologist, in addition to a radiology resident dedicated to the ED, had a significant impact on report turnaround time.

Preliminary and final report turnaround times, provided by the radiology resident and staff, respectively, for patients undergoing computed tomography or ultrasonography of their abdomen/pelvis in 2008 (before the implementation of emergency radiology in-house staff service) were compared to those performed during the same time frame in 2009 and 2010 (after staffing protocols were changed).

A total of 1,624 reports were reviewed. Overall, there was no statistically significant decrease in the preliminary report turnaround times between 2008 and 2009 (p = 0.1102), 2009 and 2010 (p = 0.6232), or 2008 and 2010 (p = 0.0890), although times consistently decreased from a median of 2.40 hours to 2.08 hours to 2.05 hours (2008 to 2009 to 2010). There was a statistically significant decrease in final report turnaround times between 2008 and 2009 (p < 0.0001), 2009 and 2010 (p < 0.0011), and 2008 and 2010 (p < 0.0001). Median final report times decreased from 5.00 hours to 3.08 hours to 2.75 hours in 2008, 2009, and 2010, respectively. There was also a significant decrease in the time interval between preliminary and final reports between 2008 and 2009 (p < 0.0001) and 2008 and 2010 (p < 0.0001) but no significant change between 2009 and 2010 (p = 0.4144).

Our results indicate that the presence of a dedicated ED radiologist significantly reduces final report turnaround time and thus may positively impact the time to ED patient disposition. Patient care is improved when attending radiologists are immediately available to read complex films, both in terms of health care outcomes and regarding the need for repeat testing. Providing emergency physicians with accurate imaging findings as rapidly as possible facilitates effective and timely management and thus optimizes patient care.

Poison Control Centers (PCCs) play an integral role in the preparation for and management of poison emergencies. Large-scale public health disasters, caused by both natural and human factors, may result in a drastic increase in the number of inquiries received and handled by Poison Control Centers (PCCs) in short periods of time. In order to plan and prepare for such public health emergencies, it is important for PCCs to assess their ability tohandle the surge in call volume and to examine how the unusually large number of calls could affect the level of services. On 26 January 2006, the New York City Poison Center experienced a sudden loss of telephone service.The disruption in telephone service led to the need to reroute calls from that geographical catchment area to the New Jersey Poison Information and Education System (NJPIES) for several hours.

Data from the New Jersey Poison Information and Education System was abstracted from the telephone switch's internal reporting system and the New Jersey Poison Information and Education System's electronic record system and processed with a standard spreadsheet application.

Compared to the same time and day in the previous week, the total number of calls received by the New Jersey Poison Information and Education System during the four hours after the disruption increased by 148%. A substantial rise in the number of calls was observed in almost every 15-minute increment during this four-hour (h) time period (with some of these increments increasing as much as 525%). Meanwhile, the percentage of calls answered by the New Jersey Poison Information and Education System decreased, and the percentage of calls abandoned during a 15-minute increment reached as high as 62%. Furthermore, the average time for handling calls was longer than usual in most of these 15-minute increments.

Limitations of the telephone technology, which impacted the ability of the New Jersey Poison Information and Education System to respond to the surge of calls, were observed. While the New Jersey Poison Information and Education System was able to handle the unusual increase of incoming calls using available poison specialists and staff, the experience gained from this natural experiment demonstrates the need for Poison Control Centres to have a pre-planned surge capacity protocol that can be implemented rapidly during a public health emergency. A number of challenges that Poison Control Centres must meet in order to have adequate surge capacity during such events were identified.