ClinicalRadiology(1992)46, 124 127
Is Radiology a 'Nine to Five' Speciality? J. G. MOSS and J. T. M U R C H I S O N
Department of Radiology, Royal Infirmary of Edinburgh, Edinburgh The role of the radiologist in 'out of hours' radiology was prospectively studied in a single Scottish Health Board for a continuous 6 month period. Six hundred and sixty seven procedures were performed by radiologists. Computed tomography (CT) (274, 41%), ultrasound scans (190, 28.5%) and vascular/interventional procedures (60, 9%) were the most frequently performed procedures. Trauma accounted for 139 (24%) of all 'out of hours' work and overall 365 (54.7%) procedures yielded an abnormality. The workload varied widely between hospitals from two procedures per 100 beds to 137 procedures per 100 beds. Similarly the input from individual radiologists was very variable. A registrar was present for 227 (34%) procedures, a senior registrar for 360 (54%) and a consultant for 138 (20%) (there being two radiologists present for 8.7% of procedures). 'Consultant only' radiology departments offering a full radiological service may expect a substantial 'out of hours' commitment. Moss, J.G. & Murchison, J.T. (1992). Clinical Radiology 46, 124 127. Is Radiology a 'Nine to Five' Speciality?
Accepted for Publication 21 February 1992
Radiological investigations outside normal working hours have received little attention in the literature. Most of the available research examines radiographers' workload, particularly in relation to plain film radiography [1], with only a brief mention of 'out of hours' CT, intravenous urography and angiography [2]. The 'out of hours' workload of the 'night radiologist' at the St Anthony's Medical Centre, St Louis, USA, has been reviewed [3]. However, the practice at this American centre, which involves an in-hospital radiologist working from 4 pm to 11 pm performing duties which include interpretation of emergency plain films and supervision of elective CT lists, is not directly comparable with the situation in most UK radiology departments. A recent survey conducted by the Office of Manpower Economics (based on a postal questionnaire from a sample of only 3.25% of UK consultants) indicated that consultant radiologists spend 1.4 h a week doing emergency recall work. This is compared with a maximum of 4.9 h in paediatrics to 0.2 h in pathology [4]. Following this survey, notional half day (NHD) allowances have been allocated for emergency on-call work. Radiologists have been awarded one quarter N H D along with geriatrics, dermatology, pathology, mental illness and orthodontics. The maximum allowance is two N H D s for general surgeons and paediatricians. These have been accepted by the Department of Health and could be used in drawing up consultant contracts. It is our impression that radiologists in the UK are being increasingly required to perform 'out of hours' radiological procedures or interpret some of the more complex imaging examinations. The purpose of this study was to prospectively audit all 'out of hours' radiological procedures performed by radiologists in a single Scottish Health Board (Lothian Health Board). Correspondence to: J. G. Moss, Department of Radiology, Royal Infirmary of Edinburgh, 1 Lauriston Place, Edinburgh EH3 9YW.
METHODS Ten hospitals which provide almost all the 'out of hours' radiology for Lothian Health Board (Fig. t) were invited to participate. Hospitals A and B are the two main Edinburgh teaching hospitals. Hospital A (1065 beds) contains the cardiac surgery centre for South East Scotland and receives major trauma including head injuries. Hospital B (611 beds) has the regional renal transplant unit. Hospital C (72 beds) is the neurosciences centre for South East Scotland, and hospital D (172 beds) is a paediatric hospital. Hospital E (159 beds) is a maternity hospital with a neonatal intensive care unit. All these hospitals have both junior and consultant radiologists 'on call'. Hospital F (267 beds) is an elective orthopaedic hospital, and hospitals G (364 beds), H (501 beds), J (74 beds) and K (523 beds) are District General type hospitals and operate 'consultant only' on call systems. At the time of the study accident and emergency departments existed at hospitals A,'B, D and H. Hospitals A and C have CT scanners. Both the junior (n = 16) and consultant radiologists (n = 25) were asked to complete a simple form (Fig. 2) for every 'out of hours' request when they either supervised or performed a procedure or reported a radiological examination. 'Out of hours' was defined as 1700 h to 0900 h on weekdays and all hours on Saturday, Sunday and national holidays. The study period was 6 months (June 1989 to November 1989) and included two national holidays. Early in the study the question on the audit form (Fig~ 2) regarding patient management was abandoned as many radiologists felt unable to comment without all the clinical information available and the value of a normal investigation was not assessed. Although most of the workload was generated within the Lothian Health Board, some CT, paediatric and vascular work came from adjacent Health Boards.
IS RADIOLOGY A 'NINE TO FIVE' SPECIALITY.9
125
1
N
I 6
I 18
I 0 Scale: miles
Fig. 1
M a p of Lothian Health Board catchment area (resident population 742 900).
RESULTS Six hundred and sixty seven forms were completed and returned for the 6 month period. Seven of the 25 consultants and one of the nine senior registrars did not complete a form. In the case of the senior registrar this was due to non-compliance, but the explanation was not apparent for consultants. Hospital F (an elective orthopaedic hospital) had no demand for 'out of hours' radiology and hospital K (thoracic medicine and surgery) did not complete any forms. The workload for the remaining nine hospitals is shown in Table 1. There was no significant variation in workload for each month. The daily distribution of work is shown in Table 2 and 61% was performed over the weekend period. Table 3 indicates the type and number of radiological procedures. CT scans and ultrasound examinations constituted almost 70% of the workload. Further analysis of these groups revealed 255 (93%) of the CT scans to be head scans and 173 (87%) of the ultrasound scans to be abdominal or pelvic scans. There was a wide range of clinical circumstances which demanded 'out of hours' radiology (Table 4); trauma was clearly the most c o m m o n indication accounting for 159 (24{'/0) procedures. Trauma, suspected subarachnoid haemorrhage or a pre-lumbar puncture CT accounted for 168 (66%) CT scans (Table 5). The five most frequent conditions requiring an ultrasound examination are shown in Table 6. Sixty interventional or vascular procedures were carried out, diagnostic angiography accounting for 23 of these (Table 7). Fifty-four percent of the work was either performed or supervised by a senior registrar (Table 8). The distribution of work amongst the registrar and senior registrar groups was fairly even, but 80% of the consultant workload was performed by 40% of the consultants. Twenty-two (49%) of the procedures supervised by consultants were vascular or interventional cases.
Although no direct assessment was made regarding the contribution to patient management of 'out of hours' radiology, the incidence of an abnormal radiological finding varied from 44% to 70% (mean 54.7"/o) from hospital to hospital (Table 9). For individual procedures the incidence of an abnormal radiological finding varied fi-om 14% for ultrasound in suspected aortic aneurysm to 79% for ultrasound in renal failure. Three of the senior registrars (65, 52 and 51 procedures) were the busiest radiologists. The busiest consultant (18 procedures) was from hospital G, a District General Hospital without junior staff. This was closely followed by a neuroradiologist (15 procedures) from hospital C, a paediatric radiologist (14 procedures) from hospital D, and two interventional radiologists (14 and 13 procedures) from hospital A. DISCUSSION On average I I 1 'out of hours' procedures were performed each month. This is undoubtedly an underestimate and indeed a comparison with the radiographers 'call-out' figures for CT in hospitals A and C suggests that an audit form was not completed by the radiologist in 27% and 33% of cases respectively. The true monthly workload is therefore more likely to be between 140 and 150 procedures. There is no doubt that CT, ultrasound and vascular/ interventional procedures respectively are the three most frequently requested and any hospital offering these services should expect an active 'out of hours' schedule. It was no surprise to find that 587 (88%) procedures involved the junior staff, as it reflects the traditional oncall system in British teaching hospitals and also that the registrar or senior registrar were capable of completing most procedures. A consultant was present for 138 (20%) procedures but this varied widely with a minority of consultants doing the majority of the consultant work.
126
CLINICAL RADIOLOGY
"Out of H ours' R a d i o l o g y A u d i t Please complete this form for all procedures performed by a radiologist out-with normal working hours (including Saturday mornings) Date
I
89
Day
_
_
Time_
Fq
Were you in bed?
I
Patient's name
Date of birth
I
I
What was the radiological procedure?
Reason for the procedure
W si.
.orma, I
I Abnormo, I
I quivoca, I
:
Did it in your opinion alter management? If yes, how?
Other comments
.....................
Seniority
Radiologist's name Did you call a more senior radiologist? If yes, who? Did he/she
[ Attend ]
I Perform I
Supervise I
theprocedure?
Hospital RHSC I Fig. 2 - Audit form used in study. T h i s c a n be p a r t l y e x p l a i n e d by the different skills offered by c o n s u l t a n t s with s o m e o f the m o r e s e n i o r h a v i n g n o C T experience a n d the i n t e r v e n t i o n a l w o r k o n l y b e i n g p r a c tised b y a small n u m b e r o f c o n s u l t a n t s . I n a d d i t i o n o n l y h o s p i t a l s A a n d C possessed a C T u n i t a n d m o s t o f the t r a u m a p r e s e n t e d to h o s p i t a l A. T h e wide v a r i a t i o n in w o r k l o a d b e t w e e n h o s p i t a l s is largely d u e to the availa b i l i t y o f e q u i p m e n t a n d the clinical services offered b y t h a t hospital. H o w e v e r , we c a n n o t rule o u t differences b e t w e e n h o s p i t a l s in h o w they deal with r a d i o l o g i c a l requests made 'out of hours'. Table 1 - Total number of 'out of hours' procedures
Hospital
Total number (%)
Number per 100 beds*
A B C D E G H J
436 36 99 43 5 26 16 3
41 7 137 25 2 7 3 3
Teaching hospital with CT Teaching hospital Neuroscience centre with CT Paediatric hospital Maternity hospital DGH-type hospital DGH-type hospital DGH-type hospital
Total
(65.4) (5.5) (14.8) (6.5) (0.7) (4.3) (2.4) (0.4)
667 (100)
* Shows adjusted results when corrected for bed number differences between hospitals.
Table 2 - Number of 'out of hours' procedures for each day
Day
Total number (%)
Average number pet" day
Monday Tuesday Wednesday Thursday Friday Saturday Sunday Public holidays (2 days)
49 43 40 46 46 262 150 31
1.9 1.7 1.5 1.8 1.8 10.1 9.6 15.5
Total
667 (100)
(7.3) (6.4) (6.0) (6.9) (6.9) (39.3) (22.5) (4.7)
Table 3 - Type of radiologieal procedure
Number (%)
CT Scan Ultrasound Vascular/intraventional Venography Intravenous urography Perfusion lung scans Gastrointestinal contrast studies Myelography Others
274 190 60 43 37 25 21 8 9
(41) (29) (9) (6) (6) (4) (3) (1) (1)
Total
667 (100)
127
IS RADIOLOGY A 'NINE TO FIVE' SPECIALITY? Table 4 - Clinical indication for 'out o f hours' radiology
Table 8 - Radiologist workload related to seniority
Number (%) Trauma Subarachnoid haemorrhage or pre-lumbar puncture Renal failure/obstruction Deep venous thrombosis Cerebrovascular accident or epileptic fit Sepsis Raised intracranial pressure Renal colic Pulmonary embolus Aortic aneurysm Acute cholecystitis Gastrointestinal obstruction Ischaemic extremity Abdominal mass Gastrointestinal haemorrhage Jaundice Ectopic pregnancy Others ,
159 74 52 48 41 31 30 30 30 16 16 13 11 10 9 8 8 70
(23.9) (11.1) (7.8) (7.2) (6.2) (4.7) (4.5) (4.5) (4.5) (2.4) (2.4) (1.9) (1.6) (1.5) (1.3) (1.2) (1.2) (10.5)
Total
667 (100)
Consultant Senior registrar Registrar
Number of procedures performed
Number of procedures supervised
Total ~%) *
93 347 227
45 13 0
138 (20) 360 (54) 227 (34)
* Two radiologists were present for 58 (8.7%) procedures.
Table 9 - Incidence o f abnormal investigations for individual hospitals
Hospital A
Number (%) 43 (56)
B
16 (44)
C
49 (49)
D
30 (70)
E G H J
3 13 9 2
Total
(60) (50) (56) (67)
365
Table 5 - Clinical indication for a C T head scan
Number (%) Trauma Subarachnoid haemorrhage or 'we-lumbar puncture' Cerebrovascular accident or epileptic fit Raised intracranial pressure Post-operative neurosurgical Others Totals
98 70 41 30 6 l0
(38.5) (27.5) (16) (11.8) (2.3) (3.9)
255 (100)
Table 6 - Clinical indications for an ultrasound examination
Number (%) Trauma Renal failure/obstruction Sepsis Gallstones Aortic aneurysm Other Total
32 29 25 24 14 66
(17) (!5) (13) (12.5) (7.5) (35)
Procedure time was not recorded in the study; however, assuming the average total time including travel (excluding telephone time) per procedure is approximately 1.5 h, the busiest consultant spent 1.04 h per week and the busiest junior 3.75 h per week on 'out of hours' work. This compares with 1.4 h in the Office of Manpower Economics Survey [4]. In conclusion, there is a significant amount of 'out of hours' radiology, which varies widely from hospital to hospital and radiologist to radiologist. In teaching hospitals most of this is carried out by junior staff. However the situation in a District General Hospital will be different. Such a hospital, if offering CT, interventional and ultrasound 'on call' facilities, particularly if staffed only by consultants will have a potentially considerable 'on call' commitment, and as has been recently suggested [5], the current N H D allowances may be inadequate and merit further investigation. The most recent advice from the Royal College of Radiologists suggests one N H D for both D G H and Teaching Hospital staff is appropriate for the 'on call' commitment [6].
190 (100) A c k n o w l e d g e m e n t s . We thank Dr P. Donnan of the Department of Medical Statistics, University of Edinburgh.
REFERENCES Table 7 - Types o f interventional or vascular procedure
Number (%) Diagnostic angiography Therapeutic enema reduction (children) Percutaneous nephrostomy Inferior vena cava filter Foreign body removal (children) Thrombolysis Vascular embolization
23 (38.3) 12 (20) II (18.3) 6 (10) 4 (6.7) 3 (5)
Total
60 (100)
1 (1.7)
! Clarke JA, Adams JE. A critical appraisal of 'out-of-hours' radiography in a major teaching hospital. British Journal of Radiology 1988;61:1100 1105. 2 Charny MC, Roberts GM, Roberts CT. Out-of-hours radiology: a suitahle case for audit? British Journal of Radiology 1987;60:553 556. 3 Fries JW. Night radiology. American Journal c~f Radiology 1985; 145: 1091 [092. 4 Review Body on Doctors' and Dentists' Remuneration, 20th report. London: HMSO, 1990 (CMND 937). 5 Bloomberg TJ. The Royal College of Radiologists (Newsletter) 1989;23:55. 6 Royal College of Radiologists. Guide to Job Descriptions, Job Plans and Work Programmes. August 1990.
Is Radiology a 'Nine to Five' Speciality? J. G. MOSS and J. T. M U R C H I S O N
Department of Radiology, Royal Infirmary of Edinburgh, Edinburgh The role of the radiologist in 'out of hours' radiology was prospectively studied in a single Scottish Health Board for a continuous 6 month period. Six hundred and sixty seven procedures were performed by radiologists. Computed tomography (CT) (274, 41%), ultrasound scans (190, 28.5%) and vascular/interventional procedures (60, 9%) were the most frequently performed procedures. Trauma accounted for 139 (24%) of all 'out of hours' work and overall 365 (54.7%) procedures yielded an abnormality. The workload varied widely between hospitals from two procedures per 100 beds to 137 procedures per 100 beds. Similarly the input from individual radiologists was very variable. A registrar was present for 227 (34%) procedures, a senior registrar for 360 (54%) and a consultant for 138 (20%) (there being two radiologists present for 8.7% of procedures). 'Consultant only' radiology departments offering a full radiological service may expect a substantial 'out of hours' commitment. Moss, J.G. & Murchison, J.T. (1992). Clinical Radiology 46, 124 127. Is Radiology a 'Nine to Five' Speciality?
Accepted for Publication 21 February 1992
Radiological investigations outside normal working hours have received little attention in the literature. Most of the available research examines radiographers' workload, particularly in relation to plain film radiography [1], with only a brief mention of 'out of hours' CT, intravenous urography and angiography [2]. The 'out of hours' workload of the 'night radiologist' at the St Anthony's Medical Centre, St Louis, USA, has been reviewed [3]. However, the practice at this American centre, which involves an in-hospital radiologist working from 4 pm to 11 pm performing duties which include interpretation of emergency plain films and supervision of elective CT lists, is not directly comparable with the situation in most UK radiology departments. A recent survey conducted by the Office of Manpower Economics (based on a postal questionnaire from a sample of only 3.25% of UK consultants) indicated that consultant radiologists spend 1.4 h a week doing emergency recall work. This is compared with a maximum of 4.9 h in paediatrics to 0.2 h in pathology [4]. Following this survey, notional half day (NHD) allowances have been allocated for emergency on-call work. Radiologists have been awarded one quarter N H D along with geriatrics, dermatology, pathology, mental illness and orthodontics. The maximum allowance is two N H D s for general surgeons and paediatricians. These have been accepted by the Department of Health and could be used in drawing up consultant contracts. It is our impression that radiologists in the UK are being increasingly required to perform 'out of hours' radiological procedures or interpret some of the more complex imaging examinations. The purpose of this study was to prospectively audit all 'out of hours' radiological procedures performed by radiologists in a single Scottish Health Board (Lothian Health Board). Correspondence to: J. G. Moss, Department of Radiology, Royal Infirmary of Edinburgh, 1 Lauriston Place, Edinburgh EH3 9YW.
METHODS Ten hospitals which provide almost all the 'out of hours' radiology for Lothian Health Board (Fig. t) were invited to participate. Hospitals A and B are the two main Edinburgh teaching hospitals. Hospital A (1065 beds) contains the cardiac surgery centre for South East Scotland and receives major trauma including head injuries. Hospital B (611 beds) has the regional renal transplant unit. Hospital C (72 beds) is the neurosciences centre for South East Scotland, and hospital D (172 beds) is a paediatric hospital. Hospital E (159 beds) is a maternity hospital with a neonatal intensive care unit. All these hospitals have both junior and consultant radiologists 'on call'. Hospital F (267 beds) is an elective orthopaedic hospital, and hospitals G (364 beds), H (501 beds), J (74 beds) and K (523 beds) are District General type hospitals and operate 'consultant only' on call systems. At the time of the study accident and emergency departments existed at hospitals A,'B, D and H. Hospitals A and C have CT scanners. Both the junior (n = 16) and consultant radiologists (n = 25) were asked to complete a simple form (Fig. 2) for every 'out of hours' request when they either supervised or performed a procedure or reported a radiological examination. 'Out of hours' was defined as 1700 h to 0900 h on weekdays and all hours on Saturday, Sunday and national holidays. The study period was 6 months (June 1989 to November 1989) and included two national holidays. Early in the study the question on the audit form (Fig~ 2) regarding patient management was abandoned as many radiologists felt unable to comment without all the clinical information available and the value of a normal investigation was not assessed. Although most of the workload was generated within the Lothian Health Board, some CT, paediatric and vascular work came from adjacent Health Boards.
IS RADIOLOGY A 'NINE TO FIVE' SPECIALITY.9
125
1
N
I 6
I 18
I 0 Scale: miles
Fig. 1
M a p of Lothian Health Board catchment area (resident population 742 900).
RESULTS Six hundred and sixty seven forms were completed and returned for the 6 month period. Seven of the 25 consultants and one of the nine senior registrars did not complete a form. In the case of the senior registrar this was due to non-compliance, but the explanation was not apparent for consultants. Hospital F (an elective orthopaedic hospital) had no demand for 'out of hours' radiology and hospital K (thoracic medicine and surgery) did not complete any forms. The workload for the remaining nine hospitals is shown in Table 1. There was no significant variation in workload for each month. The daily distribution of work is shown in Table 2 and 61% was performed over the weekend period. Table 3 indicates the type and number of radiological procedures. CT scans and ultrasound examinations constituted almost 70% of the workload. Further analysis of these groups revealed 255 (93%) of the CT scans to be head scans and 173 (87%) of the ultrasound scans to be abdominal or pelvic scans. There was a wide range of clinical circumstances which demanded 'out of hours' radiology (Table 4); trauma was clearly the most c o m m o n indication accounting for 159 (24{'/0) procedures. Trauma, suspected subarachnoid haemorrhage or a pre-lumbar puncture CT accounted for 168 (66%) CT scans (Table 5). The five most frequent conditions requiring an ultrasound examination are shown in Table 6. Sixty interventional or vascular procedures were carried out, diagnostic angiography accounting for 23 of these (Table 7). Fifty-four percent of the work was either performed or supervised by a senior registrar (Table 8). The distribution of work amongst the registrar and senior registrar groups was fairly even, but 80% of the consultant workload was performed by 40% of the consultants. Twenty-two (49%) of the procedures supervised by consultants were vascular or interventional cases.
Although no direct assessment was made regarding the contribution to patient management of 'out of hours' radiology, the incidence of an abnormal radiological finding varied from 44% to 70% (mean 54.7"/o) from hospital to hospital (Table 9). For individual procedures the incidence of an abnormal radiological finding varied fi-om 14% for ultrasound in suspected aortic aneurysm to 79% for ultrasound in renal failure. Three of the senior registrars (65, 52 and 51 procedures) were the busiest radiologists. The busiest consultant (18 procedures) was from hospital G, a District General Hospital without junior staff. This was closely followed by a neuroradiologist (15 procedures) from hospital C, a paediatric radiologist (14 procedures) from hospital D, and two interventional radiologists (14 and 13 procedures) from hospital A. DISCUSSION On average I I 1 'out of hours' procedures were performed each month. This is undoubtedly an underestimate and indeed a comparison with the radiographers 'call-out' figures for CT in hospitals A and C suggests that an audit form was not completed by the radiologist in 27% and 33% of cases respectively. The true monthly workload is therefore more likely to be between 140 and 150 procedures. There is no doubt that CT, ultrasound and vascular/ interventional procedures respectively are the three most frequently requested and any hospital offering these services should expect an active 'out of hours' schedule. It was no surprise to find that 587 (88%) procedures involved the junior staff, as it reflects the traditional oncall system in British teaching hospitals and also that the registrar or senior registrar were capable of completing most procedures. A consultant was present for 138 (20%) procedures but this varied widely with a minority of consultants doing the majority of the consultant work.
126
CLINICAL RADIOLOGY
"Out of H ours' R a d i o l o g y A u d i t Please complete this form for all procedures performed by a radiologist out-with normal working hours (including Saturday mornings) Date
I
89
Day
_
_
Time_
Fq
Were you in bed?
I
Patient's name
Date of birth
I
I
What was the radiological procedure?
Reason for the procedure
W si.
.orma, I
I Abnormo, I
I quivoca, I
:
Did it in your opinion alter management? If yes, how?
Other comments
.....................
Seniority
Radiologist's name Did you call a more senior radiologist? If yes, who? Did he/she
[ Attend ]
I Perform I
Supervise I
theprocedure?
Hospital RHSC I Fig. 2 - Audit form used in study. T h i s c a n be p a r t l y e x p l a i n e d by the different skills offered by c o n s u l t a n t s with s o m e o f the m o r e s e n i o r h a v i n g n o C T experience a n d the i n t e r v e n t i o n a l w o r k o n l y b e i n g p r a c tised b y a small n u m b e r o f c o n s u l t a n t s . I n a d d i t i o n o n l y h o s p i t a l s A a n d C possessed a C T u n i t a n d m o s t o f the t r a u m a p r e s e n t e d to h o s p i t a l A. T h e wide v a r i a t i o n in w o r k l o a d b e t w e e n h o s p i t a l s is largely d u e to the availa b i l i t y o f e q u i p m e n t a n d the clinical services offered b y t h a t hospital. H o w e v e r , we c a n n o t rule o u t differences b e t w e e n h o s p i t a l s in h o w they deal with r a d i o l o g i c a l requests made 'out of hours'. Table 1 - Total number of 'out of hours' procedures
Hospital
Total number (%)
Number per 100 beds*
A B C D E G H J
436 36 99 43 5 26 16 3
41 7 137 25 2 7 3 3
Teaching hospital with CT Teaching hospital Neuroscience centre with CT Paediatric hospital Maternity hospital DGH-type hospital DGH-type hospital DGH-type hospital
Total
(65.4) (5.5) (14.8) (6.5) (0.7) (4.3) (2.4) (0.4)
667 (100)
* Shows adjusted results when corrected for bed number differences between hospitals.
Table 2 - Number of 'out of hours' procedures for each day
Day
Total number (%)
Average number pet" day
Monday Tuesday Wednesday Thursday Friday Saturday Sunday Public holidays (2 days)
49 43 40 46 46 262 150 31
1.9 1.7 1.5 1.8 1.8 10.1 9.6 15.5
Total
667 (100)
(7.3) (6.4) (6.0) (6.9) (6.9) (39.3) (22.5) (4.7)
Table 3 - Type of radiologieal procedure
Number (%)
CT Scan Ultrasound Vascular/intraventional Venography Intravenous urography Perfusion lung scans Gastrointestinal contrast studies Myelography Others
274 190 60 43 37 25 21 8 9
(41) (29) (9) (6) (6) (4) (3) (1) (1)
Total
667 (100)
127
IS RADIOLOGY A 'NINE TO FIVE' SPECIALITY? Table 4 - Clinical indication for 'out o f hours' radiology
Table 8 - Radiologist workload related to seniority
Number (%) Trauma Subarachnoid haemorrhage or pre-lumbar puncture Renal failure/obstruction Deep venous thrombosis Cerebrovascular accident or epileptic fit Sepsis Raised intracranial pressure Renal colic Pulmonary embolus Aortic aneurysm Acute cholecystitis Gastrointestinal obstruction Ischaemic extremity Abdominal mass Gastrointestinal haemorrhage Jaundice Ectopic pregnancy Others ,
159 74 52 48 41 31 30 30 30 16 16 13 11 10 9 8 8 70
(23.9) (11.1) (7.8) (7.2) (6.2) (4.7) (4.5) (4.5) (4.5) (2.4) (2.4) (1.9) (1.6) (1.5) (1.3) (1.2) (1.2) (10.5)
Total
667 (100)
Consultant Senior registrar Registrar
Number of procedures performed
Number of procedures supervised
Total ~%) *
93 347 227
45 13 0
138 (20) 360 (54) 227 (34)
* Two radiologists were present for 58 (8.7%) procedures.
Table 9 - Incidence o f abnormal investigations for individual hospitals
Hospital A
Number (%) 43 (56)
B
16 (44)
C
49 (49)
D
30 (70)
E G H J
3 13 9 2
Total
(60) (50) (56) (67)
365
Table 5 - Clinical indication for a C T head scan
Number (%) Trauma Subarachnoid haemorrhage or 'we-lumbar puncture' Cerebrovascular accident or epileptic fit Raised intracranial pressure Post-operative neurosurgical Others Totals
98 70 41 30 6 l0
(38.5) (27.5) (16) (11.8) (2.3) (3.9)
255 (100)
Table 6 - Clinical indications for an ultrasound examination
Number (%) Trauma Renal failure/obstruction Sepsis Gallstones Aortic aneurysm Other Total
32 29 25 24 14 66
(17) (!5) (13) (12.5) (7.5) (35)
Procedure time was not recorded in the study; however, assuming the average total time including travel (excluding telephone time) per procedure is approximately 1.5 h, the busiest consultant spent 1.04 h per week and the busiest junior 3.75 h per week on 'out of hours' work. This compares with 1.4 h in the Office of Manpower Economics Survey [4]. In conclusion, there is a significant amount of 'out of hours' radiology, which varies widely from hospital to hospital and radiologist to radiologist. In teaching hospitals most of this is carried out by junior staff. However the situation in a District General Hospital will be different. Such a hospital, if offering CT, interventional and ultrasound 'on call' facilities, particularly if staffed only by consultants will have a potentially considerable 'on call' commitment, and as has been recently suggested [5], the current N H D allowances may be inadequate and merit further investigation. The most recent advice from the Royal College of Radiologists suggests one N H D for both D G H and Teaching Hospital staff is appropriate for the 'on call' commitment [6].
190 (100) A c k n o w l e d g e m e n t s . We thank Dr P. Donnan of the Department of Medical Statistics, University of Edinburgh.
REFERENCES Table 7 - Types o f interventional or vascular procedure
Number (%) Diagnostic angiography Therapeutic enema reduction (children) Percutaneous nephrostomy Inferior vena cava filter Foreign body removal (children) Thrombolysis Vascular embolization
23 (38.3) 12 (20) II (18.3) 6 (10) 4 (6.7) 3 (5)
Total
60 (100)
1 (1.7)
! Clarke JA, Adams JE. A critical appraisal of 'out-of-hours' radiography in a major teaching hospital. British Journal of Radiology 1988;61:1100 1105. 2 Charny MC, Roberts GM, Roberts CT. Out-of-hours radiology: a suitahle case for audit? British Journal of Radiology 1987;60:553 556. 3 Fries JW. Night radiology. American Journal c~f Radiology 1985; 145: 1091 [092. 4 Review Body on Doctors' and Dentists' Remuneration, 20th report. London: HMSO, 1990 (CMND 937). 5 Bloomberg TJ. The Royal College of Radiologists (Newsletter) 1989;23:55. 6 Royal College of Radiologists. Guide to Job Descriptions, Job Plans and Work Programmes. August 1990.
