After-hours adjustments: 3 ways to help radiologists handle irregular schedules

Demand for real-time imaging services has increased over time, leading to more and more radiologists working irregular hours. A recent article in the American Journal of Roentgenology examined ways hospitals and imaging centers can minimize the potential negative side effects after-hours work can have on radiologists.

Saurabh Rohatgi, MD, division of emergency radiology at the Emory School of Medicine department of radiology, and colleagues wrote that this increased demand exposes radiologists to the same negative side effects of any other healthcare provider working around the clock as well as additional radiology-specific issues.

“Diagnostic radiologists are often seated in a dark room, continuously engaged in rapid, detail-oriented work with an electronic interface and limited face-to-face personal interactions,” the authors wrote. “These conditions combine to create an environment different from that experienced by other health care workers.”

One of the most severe potential negative side effects of after-hours radiology is the impact it has on the radiologist’s sleep cycle.

“The challenges of after-hours shift work encountered by radiologists stem primarily from disturbances of the normal sleep-wake cycle, which is controlled by circadian and homeostatic processes,” the authors wrote. “After-hours shift work leads to changes in both light exposure and sleep times, which desynchronize these processes. Misalignments in the circadian and homeostatic process can negatively affect the personal and professional lives of after-hours radiologists and consequently have a wider community impact.”

Rohatgi et al. also wrote that a disturbed sleep-wake cycle can wreak havoc on a the entire body.

“Gastrointestinal disturbances, including abdominal pain and temporary variations in bowel habits, are among those more commonly encountered among after-hours workers,” the authors wrote. “Peptic ulcer disease is particularly prevalent. Metabolic syndrome is another important consequence of routine after-hours shift work. This syndrome is a combination of risk factors for the development of type 2 diabetes mellitus and cardiovascular disease that includes central obesity, hypertension, hypertriglyceridemia, lowered level of high-density lipoprotein cholesterol, and fasting hyperglycemia.”

Cardiovascular disease, decreased quality of work, and damaged personal lives are other challenge associated with after-hours radiology.

But what can the hospital or imaging center do to minimize these risks and help radiologists maintain their composure, health, and sanity? The authors offered up four helpful suggestions.

1. Staff the right radiologists

It may not always work out this way, but you should always strive to use radiologists after hours who are openly willing to do it. Radiologist who have no qualms with the shift in their schedule may do a better job of handling the change.

The authors also listed a few additional traits management should look for in individuals who could move to after-hours work.

“Sleep flexibility and predisposition to ‘eveningness’ are predictive of success with overnight shift work,” the authors wrote. “An additional general staffing note pertains to age because younger age is related to greater tolerance of overnight shift work.”

2. Create schedules with the radiologists’ well-being in mind

“Although the volume of work and workers available may ultimately dictate the structure of the schedule adopted by a given practice, the after-hours schedule should be devised with the foreknowledge that the design of the schedule (e.g., start and end times, shift duration) can greatly influence worker well-being and performance,” the authors wrote.

Some of the author’s tips for scheduling after-hours shifts include:

• Make the shift 12 hours or less
• Night shifts should start before midnight, preferably at 9 or 10 p.m.
• Shifts should end before sunrise
• Use more than one radiologist when possible, to allow breaks and personal interaction
• Provide at least two days for adjusting from night shift to another shift

3. Ease the transition

After the final shift in a series of late-night shifts, radiologists often try to sleep as much as possible the next day to “catch up.” However, the authors recommend a different solution.

“On the basis of our collective experiences, we recommend a short morning nap that ends at midday,” the authors wrote. “We have found this practice to facilitate reset of the normal sleep-wake cycle, although a complete return to normal can take several days.”

Managers should communicate with their radiologists and make sure they understand this important step.