By Ania Kielar
COVID-19 has made it evident that our nation’s health system has incredibly little built-in redundancy. Both human resources and equipment are operating to their maximum capacity. Even at maximum output, wait lists for imaging are growing. In a time of crisis, this can result in personnel burnout and system failure.
To meet a growing demand for medical imaging, we know that capacity in radiology needs to increase, and that additional equipment will help to build a more resilient health system for patients. Equipment procurement and renewal are a medium/long-term solution to an immediate problem and other solutions need to be considered concurrently.
Optimizing our imaging capacity
Optimization of our current imaging capacity will mean scanning more patients per year without increasing the amount of available equipment. Completing more scans will require additional human resources (administrative staff, technologists, nursing, cleaning, radiologists), and will necessitate appropriate investment in those resources.
Improving and optimizing patient throughput can decrease wait times and drive capacity improvements in the near term. Taking a careful look at the current patient journey through radiology and ensuring metrics align with throughput as well as quality can help. Barring significant increases in CT, MRI, and ultrasound capacity, the only way to increase throughput is to decrease the length of time that it takes to scan a single patient.
Given our existing equipment capacity, staffing is a factor limiting overall increases in the amount of imaging that we can perform on an institutional or regional basis. As CT and MRI examinations are in high demand, most of these scanners are being operated at maximum capacity, limited by staffing constraints. In some jurisdictions, the only way to increase capacity is not only increase staffing but also increase the number of units. Adding to technologists’ and sonographers’ current workloads will have significant physical and psychological effects on a workforce that was already being challenged before the onset of the pandemic.
In theory, it is possible to optimize our existing capacity through improved scheduling. Scheduling and exam time are the most easily adjusted variables in the equation. However, increased scheduling density and intensity can rapidly lead to burnout of imaging staff, including schedulers, nurses, technologists, and radiologists. Radiology is already a specialty at a high-risk of burnout, due to heavy workloads and the ceaseless demand for round-the-clock medical imaging.
A 2018 mental health study conducted for technologists and sonographers found high levels of emotional exhaustion, in additional to other indicators of burnout. Associations and colleges have started to recognize the mental health needs of their memberships and are working towards national initiatives to support their professionals in the workplace. The pandemic has added layers of psychological effects on the workforce which are not well understood to date, but evidence is emerging demonstrating increased mental health burden on health professionals.
Increasing the pool of available technologists will have several benefits including reducing wait times, reducing burden on existing staff, and increasing staffing flexibility. Additional infection prevention and control (cleaning) staff were also identified as priorities, as were additional administrative staff. In cases where technologists are pulled into infection control or administrative roles and away from patient care, staffing challenges become magnified. It is essential that departments and institutions become aware of how assigned responsibilities align with the goal of effective patient care. Metrics and data should be collected to capture time spent on patient care vs. administrative vs. other duties, so that improvements can be data driven. It should be noted that initiatives aimed at quality assurance and quality improvement should be considered “patient care” rather than administrative work – within reason.
Collectively, we need to recognize the true threat of overworking staff for the sake of improving productivity metrics. As valued medical professionals, the collective wellbeing of an imaging care team will directly translate into patient wellbeing. In some cases, adding additional capacity (e.g. more scanners) is preferable over maximizing the utilization of existing systems in the interest of preventing burnout. Radiology professionals put patients first; this obligates our health care systems to recognize that these professionals are an extremely important asset worth investing in.
Ania Kielar, MD, FRCPC is an Associate Professor, University of Toronto, Deputy Chief Joint Department of Medical Imaging (JDMI), Quality and Practice Improvement.