ER takes page from Uber, using ‘surge’ teleradiology staffing during peak demand

Radiologists are taking a page from ridesharing apps such as Uber, using “surge” staffing during peak demand times amid physician shortages. 

Harvard experts on April 1 detailed the challenges of an unnamed academic emergency radiology division employing 23 radiologists with the need for more manpower. After the institution opened a new emergency department in June 2023, leaders sought to preserve turnaround times despite these staffing issues. 

To do so, they increased daily scheduled shift hours and deployed surge staffing, experts write in the Journal of the American College of Radiology. The latter involves scheduled radiologists initiating “surge” calls for assistance during high volumes, “prompting available nonscheduled staff to read remotely, with compensation based on length and time of surge engagement.” 

Researchers analyzed data from the first 60 days of the initiative, with total relative value units (RVUs) increasing by 15% while median turnaround times remained stable.

“A ‘just-in-time’ supplemental surge staffing model, in combination with increasing scheduled shift hours, can be effectively used to maintain TATs during staffing shortages, aiding timely care delivery as a bridge to more permanent staffing solutions,” Brigham and Women’s Hospital emergency radiologist Khushboo Jhala, MD, MBA, and co-authors concluded.

“Hospital X”—an academic, tertiary center—included one ER and two affiliated urgent care centers. Its ERad division was comprised of 19 dedicated core staff members along with four moonlighters, amounting to about 12.5 full-time equivalents. Before adding the new ER, the team read for five emergency departments and six urgent care centers, performing about 276,000 RVUs annually. All staffers in this hybrid-remote staffing model have access to at-home PACS (picture archiving and communication systems), the authors noted.

Prior to the project, their shift distribution during a 24-hour period included eight overlapping nine-hour shifts and a four-hour shift, totaling 76 hours. Afterward, they moved to 10 nine-hours shifts, expanding the total pot to 90 scheduled shift hours per day. This included a mix of mandatory, on-site shifts along with others that can be worked either in-person or remotely from home. Staffers got six-month notice to begin preparing for the new ER to open, but departures from a private practice handling the site added urgency. 

“The [emergency radiology] group absorbing this extra volume had weathered chronic understaffing with intermittent staff departures and hires,” Jhala and colleagues noted. “Only one new hire could be brought onboard before the addition date, creating a challenge for the already understaffed ERad team to manage a period of volatile volume increase.”

The ER’s compensation model uses a points system to reward rads for working certain less-desirable times of day. For instance, 8 a.m. to 5 p.m. is worth 1 point, 5 to 8 p.m. 1.25, while 8 p.m. to 12 a.m. is 1.5, and midnight to 8 a.m. 1.8. Points are then accrued to meet FTE expectations. Hospital X already had implemented at-home workstations during the pandemic and launched surge staffing in December 2020 amid workforce challenges. On-service radiologists utilize Microsoft Teams to contact available nonscheduled rads during periods of heavy demand. Team members who are available then can log on remotely and restore the worklist to a “more manageable length,” logging their surge times in the scheduling system in five-minute increments. Compensation is based on the duration of the surge and time of day when it occurs. 

“Although there are many possible ways to operationalize such a system, we have socialized an approximate rule of thumb that surge is warranted when there are multiple unread examinations exceeding an hour from examination completion,” the authors noted. “However, we rely on the situational awareness of those on shift to decide when help is needed, weighing additional factors such as the current and anticipated examination mix, and the roster of team members currently working or scheduled to begin their shifts in short order.”

Jhala and co-authors analyzed data from the six months leading up to the new ER opening and the half-year that followed. Among the emergency radiology staff, total RVUs increased from 38,746 up to 44,628 or 15%. Meanwhile, median turnaround times went from 42 to 44 minutes, and 80th percentile TATs also remained stable. Average RVUs per person hour also stayed flat, remaining at 8.2. Only 70% (or 16 of 23) of baseline staff members saw increases in scheduled shift hours after the ER opened. All but one radiologist (22 of 23 or 96%) took part in surge, with varying durations among each staffer. Voluntary scheduled shift hour increases varied from about 2% to 41%, “highlighting different threshold capacities among radiologists.” 

“Although evenly distributing shifts may seem equitable, it can exacerbate burnout for those working over capacity and underuse those with extra capacity,” the authors advised. “An individually tailored approach may optimize staffing preferences.”

Jhala et al. highlighted the important distinction of scheduled versus surge shifts. The latter is more flexible, allowing radiologists to contribute their time in five-minute increments, where possible. 

“The lack of control over clinical schedule amid increased demand has been known to exacerbate burnout, and the surge model helps manage workflow while mitigating this downside,” the authors advised. “Of note, a majority of staff still felt inclined to help manage excess volume, even if not scheduled through a shift in advance. Universal engagement in surge may stem from a shared experience of needing and providing voluntary help, which fosters a sense of community and counters the isolation from decentralization and increased workload pressures as a sequela of the current landscape.” 

You can read much more, including potential study limitations, in the April edition of JACR.