Keywords:
Health policy and practice, Ultrasound, CT, Emergency, Audit and standards, Workforce
Authors:
A. Murchison, M. Chen, P. C. Lyon, S. Rehman, D. Grant, S. Gargalas, S. A. Nazir; Oxford/UK
DOI:
10.26044/ecr2019/C-2253
Results
Part 1
In the first part of our work,
we looked at out-of-hour reporting trends over a ten-year period.
Over this time,
the number of acute CTs reported overnight increased by 400% from an average of 4-5 per night in 2008 to 20 per night in 2018 (figure 3).
Likewise,
the average number of CTs reported per day at the weekend increased by 300% from around 20 scans to 60 scans at the end of the period (Figure 4).
There was a 250% increase in the number of acute CTs reported on evening shifts,
starting at an average of 10 reports in 2008 and increasing to 25 by 2018.
There number of weekend ultrasound scans doubled (Fig.
5),
but there was no perceptible increase in the number of ultrasounds performed by radiologists in the evening or overnight (data not shown).
Part 2
The proforma-based monitoring revealed that,
on average,
2.7 unreported CTs were handed over to the night registrar.
After introducing an additional evening (5-9pm) registrar,
handover was reduced to 1.7 CTs; the number of shifts deemed as 'too busy' has reduced from 12.5% to zero (Figs 6 and 7).
Nearly all night shifts were rated as satisfactory with 6% being rated as 'extremely satisfactory' and 12% 'very satisfactory' (Fig.
7) .
No shifts were rated as 'unsatisfactory'.
An average of 46 consults (either in the form of walk-in or phone call by the referring clinician,
including requests for imaging which needed discussion) took place during a 12-hour night shift.
Less than one third were regarded as urgent consults,
defined as requiring a scan within an hour (Fig.
9).
CT reporting accounted for the bulk of the workload overnight,
and the busiest hour of the shift was found to be 10-11 pm (Fig.
10).
This demonstrates the importance of minimising the number of CT scans handed over from the evening team for managing the workload for the night on-call registrar.