- When patients needed urgent CT scans, MRIs and ultrasounds late at night at St. Mary's Hospital in Waterbury, Conn., emergency room workers used to rouse a bleary-eyed staff radiologist from his bed to read the images. Not anymore.
The work now goes to Arjun Kalyanpur -- 8,000 miles away in Bangalore, India. When it is the middle of the night in Connecticut, Kalyanpur is in the middle of his day, handling calls from St. Mary's and dozens of other American hospitals that transmit pictures to him electronically so he can quickly assess them and advise their doctors.
Kalyanpur runs one of an increasing number of "nighthawk" companies operating in the United States and overseas to take advantage of time-zone differences and the latest technology by having radiologists read images from such far-flung places as Hawaii, India, Australia, Switzerland, Israel and Brazil.
The companies, and the doctors and hospitals using them, say the trend is improving care by guaranteeing that well-rested radiologists are always available, even in the middle of the night, even for the smallest hospitals and in the most rural areas.
The advent of remote radiology services was prompted by various factors, including a shortage of radiologists and rapid advances in imaging technology, which has caused a sharp increase in the number of tests. As a result, many hospital radiologists have a hard time keeping up with the demand, especially at night.
"We don't have the staff to have some guy up all night and then come back in the next day," said Robert Lehman, who heads the St. Mary's radiology department. "It's just too dangerous."
In response, St. Mary's and hundreds of other hospitals and radiology practices have begun outsourcing, allowing their staff radiologists to come to work fresh each morning.
"I'm convinced patient care is improved," said Paul Berger of NightHawk Radiology Services. The company, based in Coeur d'Alene, Idaho, has about 40 radiologists in Zurich and Sydney serving about 600 U.S. hospitals and other facilities, including 16 in Virginia.
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Telemedicine is getting really big, and only some of the outsourcing involved is of the offshore variety.
Another exciting development is eICU, which feeds real time patient data and high resolution images to doctors located in remote locations. It's often used to supplement on-site staff, and it's especially useful in boosting the level of care in rural hospitals.
This arrangement is also 24/7 care. Many on-site specialists go home at night, which would be fine if there were no such thing as middle-of-the-night complications.