'Ad hoc' shifts and radiology 'maestros': How one department addressed its workflow hiccups
Incorporating an “ad Hoc shift” directed by a radiologist “maestro” helped one radiology department to significantly reduce some of the hiccups in its workflows.
Increasing workloads, administrative burdens and staffing shortages have been negatively affecting the well-being of radiologists for years. This has resulted in departments having to think creatively to address the issues at hand, which is exactly what the team at Children’s Hospital of Philadelphia did when they implemented their ad hoc shift—a flexible two-hour shift a lead radiologist dubbed “the maestro” can activate in real-time after assessing workflows and determining that extra hands-on-deck are needed.
“Staffing shortages and increased radiology study volumes have led to higher workloads and increased rates of burnout among pediatric radiologists,” Dana Alkhulaifat, from the Department of Radiology at the hospital, and colleagues noted in a newly published paper on their intervention.“These conditions are exacerbated by daily fluctuations in study volumes which can occur due to a plethora of reasons and can often be unpredictable."
Inconsistent fluctuations in workflow can leave a department over- or understaffed on any given day, and solutions to this problem can be costly and impractical. The "as needed" nature of the ad hoc shift helps address these things by providing greater flexibility with staffing.
The shift is implemented by the maestro, who assesses the department’s needs and makes decisions accordingly. When work lists begin to swell and exams sit beyond a certain threshold of time without being read, the maestro can contact someone from a list of pre-determined volunteer radiologists who are pre-call, post-call, assigned to academic or administrative time, or partaking in any other nonclinical assignments. That radiologist will then spend 2 hours knocking out 40-100 plain film radiographs to reduce the number of exams on the work list.
The shift, which is paid at the usual internal moonlighting hourly rate, was piloted at the hospital for a full year before the team analyzed its use. During that time, the shift was activated 35 times by 8 separate maestros.
Several trends related to use of the shift were observed, including reasons for activation and when it was utilized most frequently. It was activated the most during the launch of a new PACS, on Mondays and during the early afternoon hours (1-2 p.m.). The most common reason for activation was cited as the number of studies on the work list (54%), followed by the amount of time exams sat before being reviewed and the speed of the radiologists working that particular shift.
Post-implementation surveys from the hospital’s radiologists signaled that the change may have positively impacted staff well-being, as rates of burnout declined by nearly 20% between 2022 and 2023. Although the ad hoc shift was likely just one of many interventions that decreased burnout within the department, the group believes it provided substantial contributions to a culture of community and safety.
“Real-time access to additional staff can distribute the workload of the division during unexpected volume surges. Furthermore, this shift requires a significantly lower administrative burden and offers a low-cost alternative compared to other solutions that necessitate the onboarding of additional staff or outsourcing to outside teleradiology companies,” the team noted. “It also incentivizes fast readers who are more capable of completing tasks within a limited timeframe to alleviate some of the workload during high study volumes.”
In the future, the team believes that advancements in artificial intelligence could contribute to further improving the protocol.
Learn more about the team’s work here.
In addition to her background in journalism, Hannah also has patient-facing experience in clinical settings, having spent more than 12 years working as a registered rad tech. She began covering the medical imaging industry for Innovate Healthcare in 2021.