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Diagnostic ultrasound in British Columbia 1986 Kinnis, C.; Barer, Morris Lionel, 1951- Mar 31, 1988

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DIAGNOSTIC ULTRASOUND IN BRITISH COLUMBIA1986HMRU 88:2Health Manpower Research UnitDivision of Health Services Research and DevelopmentOffice of the Coordinator of Health SciencesThe John F. McCreary Health Sciences CentreThe University of British ColumbiaVancouver, British ColumbiaV6T lZ6C. KinnisM.L. BarerMarch 1988ACKNOWLEDGEMENTSThe assistance of Ms. Eileen Guiliani, British ColumbiaUltrasonographers' Society, Dr. Peter Cooperberg, Vancouver GeneralHospital, and the ultrasound personnel in hospitals throughout BritishColumbia who completed our questionnaire, is gratefully acknowledged. Thisresearch was supported by the B.C. Ministry of Health.TABLE OF CONTENTSList of TablesList of FiguresINTRODUCTIONSTUDY POPULATIONRESULTS1. Facilities2 . Rooms and Machines3. Procedures(a) Geographic Region(a) Procedural Mix(b) Obstetrical Ultrasound, Deliveries andTerminated Pregnancies4. Staffing(a) Numbers and Productivity(b) Vacancies(c) On-the-Job Training(d) Future Requirements5. Written CommentsSUMMARYReferencesAppendix 1: Regional Hospital Districts of British Columbiaiiiii11224710131718182022222426ifList of TablesTable 1: Number and Percentage Distribution of FacilitiesSurveyed, by HMRU Region and Size of Facility, B.C.,1986 3Table 2: Ultrasound Capacity in B.C. Hospitals, 48 Facilities,B.C., 1986 6Table 3: Number of Machines in Use and On Order, By Type ofMachine, 48 Responding Facilities, B.C., December31, 1986 6Table 4: Number and Percentage Distribution of UltrasoundProcedures Performed in British Columbia, by Typeof Facility and Admission Category, B.C., 1986 9Table 5: Ultrasound Procedures per 1,000 Population and perAcute Care Bed, by Geographic Region, B.C., 1986 12Table 6: Number of Ultrasound Procedures, by Geographic Region,Type of Procedure and Admission Status, 48 UltrasoundDepartments, B.C., 1986 16Table 7: Number of Obstetrical Ultrasound Procedures perReported Delivery and per Terminated Pregnancy, 58Ultrasound Departments, B.C., 1986 19Table 8: Number of Diagnostic Medical Sonographers, 54Ultrasound Departments, B.C., 1986 21Table 9: On-the-Job Training of Medical Sonographers, 54Ultrasound Departments, B.C., 1986 23Table 10: Future Self-Reported Staffing Requirements, 54Ultrasound Departments and 10 Other Facilities,B.C., 1986 23Table 11: Nature of Written Comments Offered RegardingUltrasound Service Provision or Technologist Staffing,54 Ultrasound Departments, B.C., 1986 25iiiList of FiguresFigure 1: Ultrasound Capacity in B.C. Hospitals, 1986Figure 2: Distribution of Ultrasound Procedures, by HMRURegion, 58 Ultrasound Departments, B.C., 1986Figure 3: Distribution of Ultrasound Procedures, by Typeof Procedure, 48 Ultrasound Departments, B.C.,198651114DIAGNOSTIC ULTRASOUND IN BRITISH COLUMBIA1986INTRODUCTIONThe Health Manpower Research Unit (HMRU) has been monitoringdiagnostic ultrasound facilities and utilization in British Columbia (B.C.)since 1979, until 1982 on an annual basis, thereafter every two years.After each survey, reports have been prepared and distributed torespondents, the Health Manpower Working Group, the B.C. Health Associationand other interested groups and individuals. The 1986 report examinedfive-year trends (1979 through 1984). The present report concentrates onavailable resources and services provided in 1986.STUDY POPULATIONIn 1986, as in 1984, a questionnaire was administered to all publichospital facilities, diagnosti c and treatment centres, and various privatehospitals, all of which were identified from the B.C. Ministry of Health(Hospital Programs) list of facilities. The questionnaire was designed toelicit information on numbers of rooms, machines, procedures performed, andpersonnel providing services.Four private laboratories known to be providing ultrasound serviceswere also surveyed, but were removed from the survey group when it wasrealized there were actually an unknown and difficu1t-to-identify number ofprivate facilities providing these services. This prompted us to revert to2Medical Services Plan (MSP) data for private laboratories' serviceprovision data. We discuss this in more detail below.The survey population, cross-classified by region and size offacility, is described in Table 1 (See Appendix 1 for a map of BritishColumbia showing the location of the nine regions). As can be seen, thelargest facilities are all located in the Greater Vancouver RegionalHospital District (GVRHD) and Capital region. Over seventy percent of thehospitals surveyed have fewer than 100 beds, and most of these arescattered among the more rural regions of the province.Six of the 112 facilities surveyed had two separate departmentsproviding ultrasound services, each of which received separatequestionnaires, for a total population of 118 ultrasound departments.Questionnaires were mailed to the survey population along with return­addressed, stamped envelopes. There were second mailings, followed bytelephone calls, to non-respondents, and a response rate of 96.6 percentwas achieved (114 of 118 ultrasound departments in 112 facilities).RESULTS1. FacilitiesFifty-two of 112 facilities (46.4%) were providing ultrasound, (upfrom 49 in 19841 ) . Another 10 facilities (9%) were expecting to be1 Actually 52 in 1984, including three private facilities.Table 1Number and Percentage Distribution* of Facilities Surveyed,By HMRU Region and Size of Facility, B.C ., 1986RATED NUMBER OF ACUTE CARE BEDSD&T500+ 400 -499 300-399 200-299 100-199 30-99 <30 Centres TotalHMRU REGION** N % N % N % N % N % N % N % N % N %GVRHD 2 1.8 2 1.8 3 2 .7 1 0 .9 7 6.2 2 1.8 17 15.2Capital 1 0 .9 1 0 .9 1 0 .9 1 0 .9 4 3 .6Fraser Valley 4 3.6 2 1.8 6 5 .4Okanagan 1 0 .9 2 1.8 1 0 .9 4 3 .6 1 0.9 9 8 .0 VJIsland Coast 1 0 .9 10 8.9 6 5.4 3 2 .7 20 17 .9South-East 1 0 .9 3 2. 7 5 4 .5 8 7 .1 3 2.7 20 17 . 9Central 1 0 .9 5 4.5 4 3 .6 3 2.7 13 11 .6North Central 1 0 .9 1 0.9 5 4 . 5 7 6 .2 2 1.8 16 14.3North 3 2 .7 2 1.8 2 1.8 7 6.2TOTAL 3 2 .7 3 2 .7 4 3 .6 4 3 .6 18 16 .1 34 30 .4 32 28.6 14 12 .5 112 100 .0* Total percentages, i .e. percent of 112** Regional Hospital Districts arbitrarily grouped by the Health Manpower Research Unit (see map, Appendix 1)4providing services within two years, and five others were thinking aboutit. This left 45 facilities not providing ultrasound and apparently notplanning to do so. All but six of these were diagnostic and treatmentcentres or had fewer than 30 beds (Figure 1). Even in the latter twocategories, three facilities were in the planning stages and three otherswere thinking about providing this service in the future . At least halfthe facilities in all nine regions of the province were at least thinkingof providing ultrasound services. None of the 14 diagnostic and treatmentcentres surveyed were ultrasound facilities.Since the four non-responding facilities were all ultrasoundproviders, there were 48 facilities remaining, or 54 ultrasound departmentswithin these facilities on which the following data are based, unlessotherwise noted.2. Rooms and MachinesThe 48 reporting facilities housed 96 ultrasound rooms in use atDecember 31, 1986 , or 95.25 full-time-equivalent (FTE) rooms for the year,for an average of 2.0 per facility (Table 2).Furthermore, the 48 facilities averaged 3.6 ultrasound machines each,or 1.8 machines per room. The 174 machines in use (and four on order) atDecember 31, 1986 are described in Table 3. Real-Time (Sector), Real-Time(Linear + Sector), Conventional B-Scan and M-Mode with Sector Scancomprised over 70 percent of all machines in use at that time.5Figure 1 : ULTRASOUND CAPACITY IN B.C. HOSPITALS, 1986(a) By HMRU RegionGVRHO_C8pit81~ IFr Valley toooaOkanagan ~'-----'IIs Coast ~~~~;;;;m;m;.-------South-East~~===:::;----Central~;;;;;;;;;;;;;=====--N Central~ -----'North~US Capacity00 Yes~ Within 2 YrsIIlIlII Consideringo No Plansi •o,10 ,I. z'oNumber of Flcllltle.i I21• Iao.'.(b) By Size of Facility(Rated Acute Clre Beds)600+~400-499~300-399~200-299 R222S100-199_3 - 9.<30~O&T Centre IL.- _US.,3.8.88I 'oI i•, ,b ' ,.. . i liD" , II,Number of Feclllti..• I •10 , .'.6Table 2Ultrasound Capacity in B.C . Hospitals,48 Facilities,* B.C. , 1986Facilities Providing UltrasoundRooms UtilizedRooms Utilized/Providing FacilityMachines UtilizedMachines Utilized/Providing FacilityMachines Utilized/Room4896**2.01743.61.8'If *Four non-responding facilities, excluded from the table, all providedultrasound in 198695 .25 ful l - time -equivalent roomsTable 3Number of Machines in Use and On Order, By Type of Machine,48 Responding Facilities , B.C. , December 31 , 1986Number Numberi n Use on OrderDec 31/86 Dec 31/86Type of Machine N % N %Conventional B-Scan 22 12.6Real-Time (Linear) 10 5.7Real-Time (Sector) 51 29.3Real-Time (Sector + B-Scan) 6 3.4Real-Time (Linear + Sector) 34 19 .5 2 50.0M-Mode (Dedicated) 7 4 .0M-Mode with Sector Scan 18 10 .3 1 25 .0Dedicated Eye Unit 6 3 .4Doppler Units :Stand Alone Continuous Wave 1 0.6In Conjunction with Real-Time:Pulse Wave 10 5.7Continuous Wave 5 2.9Colour Flow Mapping 1 25.0Pulse + Continuous Wave 3 1.7Pulse + Cont inuous Wave +Colour Flow Mapping 1 0.6TOTAL 174 100.0 4 100.073. ProceduresOur ability to report accurate data on numbers of ultrasoundprocedures for 1986 was compromised not only by the four non-respondentinstitutions, but by the fact that, increasingly, diagnostic ultrasound isbeing provided in ambulatory care settings. Together these considerationsdictated the need for an indirect method of estimating procedure counts.We had two sources of information on procedures provided to hospitalinpatients. One, of course, was the questionnaire responses. The otherwas the H1th 1535 monthly reporting forms available from Hospital Programs,B.C. Ministry of Health. Procedures provided in hospitals, but foroutpatients, and procedures provided in private facilities are reimbursedthrough the Medical Services Plan. The MSP payment tapes therefore providea source for these data. Additionally, responding hos~ita1s provided dataon outpatient procedures, permitting some cross-validation of the twosources for this component of the total.In terms of data source hierarchy, we treated the questionnaireresponses (where they provided the necessary data) as our 'primary' source,'filling in' as necessary with H1th 1535 data, and then finally using MSPdata to infer activity levels for private facilities. In addition to thefour non-responding hospitals, another five provided no procedural data.Thus, in terms of information about levels of service provision, we were,de facto, dealing with 9 non-respondents.8With these three sources of data, we proceeded as follows:(i) A scan of the MSP data for the fiscal year 1986/87 revealed atotal of 197,976 ultrasound procedures paid for during the year . 2These are labelled as 'total outpatient' in Table 4. They wereavailable by HMRU region and type of procedure (obstetric,abdominal/pelvic, eye, cardiac, Doppler, and other);(ii) A printout of Hospital Programs data, showing the numbers ofinpatient and outpatient ultrasound procedures reported by eachhospital in the province on the Hlth 1535 monthly reportingforms, was obtained for the fiscal year year 1986/87. From thisprintout, the numbers of inpatient and outpatient procedures wereobtained for each of the nine institutions which had failed toprovide procedural data;(iii) An estimate of total facilities' outpatient procedures wasconstructed by summing the outpatient data from the respondents,and Hlth 1535 data for the 9 non-respondents;(iv) The total number of outpatient procedures (from (iii» wassubtracted from the MSP procedure total «i) above) , to estimatethe number of ultrasound procedures performed by privatelaboratories.2 Because there is a 4-6 week lag between date of service and date ofpayment , 1986/87 fiscal year payment data may be considered an extremelyaccurate source of service provision data for calendar 1986.9The results of these steps are reported in Table 4. Step (iii)provided an estimate of 184,960 outpatient procedures. In light of theMSP-based total of 197,976 (step (i», we inferred a total of 13,016procedures provided in private practice settings. Our questionnaires,supplemented with H1th 1535 forms for the 9 non-respondents, yielded atotal of 58,782 procedures on inpatients. Thus, from these estimates,there were 256,758 ultrasound procedures performed in British Columbia inTable 4Number and Percentage· Distribution of Ultrasound ProceduresPerformed in British Columbia, by Type of Facility andAdmission Category, B.C., 1986InpatientN %Hospitals··Private LaboratoriesTotal58,78258,78222.922.9Outpatient TotalN % N %184,960 72.0 243,742 94.913,016+ 5.1 13,016 5.1197,976++ 77 .1 256,758 100.0Percentages are total percentages, i.e. of 256,758Hospital questionnaire data, supplemented by Hospital Programs datashowing numbers of inpatient and outpatient procedures reported on theH1th 1535 monthly reporting forms by the 4 non-respondents and 5 otherfacilities which did not provide the data+++By inference, total number of hospital outpatient procedures (184,960- see note above), subtracted from total number of "non-inpatient"procedures paid for in the fiscal year (197,976 - see note below)Total "non-inpatient" ultrasound procedures paid for during fiscalyear 1986/87. Source: physician fee-item billing data from theMedical Services Plan tapes for the fiscal year1986, of which 22.9 percent were on hospital inpatients and 72.0 percent onhospital outpatients. The remaining 5.1 percent were done by privatelaboratories.10(a) Geographic RegionOver one-half of all procedures were performed in the GVRHD with theremainder being distributed rather evenly among the other regions of theprovince (Figure 2). Those done by private laboratories, estimated (Table4) to number approximately 13,000 (5.1% of total and 6.6% of outpatientprocedures), are not identifiable by geographic region, because the totalwas based on inference rather than location-specific MSP data. Almost two­thirds of inpatient procedures, compared to 50-55 percent of outpatientprocedures, were performed in the GVRHD.These data are analyzed in per capita terms in Table 5. There were88.9 ultrasound procedures per 1000 population in 1986 (up from 71.1 in1984), with 20.3 per 1000 for inpatients and 68.5 per 1000 for outpatients(up from 17.5 and 53.6, respectively, in 1984).It must be remembered here that the location (GVRHD vs. other B.C.)refers to the location of service. Therefore the GVRHD per capita ratesare almost certainly upward-biased as population-based utilizationestimates, with the reverse holding true for 'other B.C.'. Bearing thiscaveat in mind, there were twice as many inpatient procedures per 1000population in the GVRHD than in other regions of the province. Minimum andmaximum outpatient rates were calculated, taking into account the 13,016estimated procedures done by private laboratories with unknown geographiclocation. Thus, there were between 77.1 and 87.4 outpatient procedures per1000 population in the GVRHD, and between 53.8 and 61.8 per 1000 in otherB.C.11Figure 2 DISTRIBUTION OF ULTRASOUND PROCEDURES, BY HMRUREGION, 58 ULTRASOUND DEPARTMENTS,· B.C., 1986OUTPATIENTPROCEDURES(197,976)'- Cen".'4.'"~\~ N Centr.'e.4"NorthI .• "Unknown6. I,.INPATIENTPROCEDURES(68,782)L'L~ N Cen"e'e.7"North2. I,.unknow~nn~...~TOTALPROCEDURES(266.768)• Plu. unknown number or privau I.borltorl••with unknown location. S•• Tabl ... .uu1.2..12Table 5Ultrasound Procedures per 1,000 Population and Per Acute Care Bed,by Geographic Region*, B.C., 1986B.C. Population**Inpatient ProceduresNo. per 1,000 PopulationOutpatient Procedures+No. per 1,000 PopulationTotal ProceduresNo. per 1,000 PopulationAcute Care Beds++GVRHD Other B.C. Total1,266,152 1,623,055 2,889,20737,425 21,357 58,78229.6 13.2 20 .3(min) (max) (min) (max)97,666 110,682 87,294 100,310 197,97677 .1 87.4 53.8 61.8 68.5(min) (max) (min) (max)135,091 148,107 108,651 121,667 256,758106.7 117.0 66.9 75.0 88.94,972 6,097 11,069Inpatient UltrasoundProcedures per AcuteCare BedAcute Care Beds forUltrasound Facilities++Inpatient UltrasoundProcedures per AcuteCare Bed for UltrasoundFacilities7.534,9727.533.504,9684.305.319,9405.91***+++Region of the facility providing the service, not necessarily where thepatient resides. Thus, the figures are services provided in each region,to whomever , divided by the population or bed capacity of the regionCanada Census, 1986The minimum figures are those obtained from the questionnaires,supplemented by the Hospital Programs data for the 9 facilities which didnot provide the data. The maximum figures include the 13,016 estimatedprocedures done by private laboratories - since these were notidentifiable by region, a portion would be assignable to GVRHD and theremainder to other regions of B.C.From the Hospital Programs list dated March 31, 198613Similarly, total ultrasound procedures numbered between 106.7 and117.0 per 1000 population in the GVRHD (up from 90.3 in 1984) and between66.9 and 75.0 per 1000 outside the GVRHD (up from 57.0 in 1984).Inpatient ultrasound procedures per acute care bed numbered 5.31, upconsiderably from 4.57 in 1984 (Table 5). In the GVRHD the figure was 7.53(up from 6.23 in 1984), while in other B.C. there were 3.50 (3.25 in 1984).In this case, we do not have denominator problems akin to those with theper capita rates. In other words, rates per bed are indeed twice as highin the GVRHD. This is undoubtedly partly a reflection of differences indiagnostic and severity patient mix.Removing beds from the denominator for no-ultrasound facilities in theprovince increases the rate in other B.C. to 4.30, and the provincialaverage to 5.91.(b) Procedural MixProcedural mix is displayed in Figure 3. Estimates were not preparedfor the four non-respondents or five other facilities which failed toprovide procedural information, nor was an inpatient/outpatient splitattempted for one other facility which provided a total procedural mix . Asa result, only 48 ultrasound departments are included in the top two piediagrams and 49 in the bottom one. 33 There were 54 operating ultrasound departments in the 48 respondinginstitutions. Of these 54, 5 provided no procedural data and one other didnot disaggregate its data into inpatient and outpatient.14Figure 3 : DISTRIBUTION OF ULTRASOUND PROCEDURES, BY TYPEOF PROCEDURE, 48 ULTRASOUND DEPARTMENTS,· B.C., 1986INPATIENT PROCEDURES (44,521; N=48)0111.,8.'"OUTPATIENT PROCEDURES (148,694; N==48)TOTAL PROCEDURES (205,676; N=49)• Only 48 of 68 ultruound depertments provided procedurn crou-cl8lsified by type ofprocedure and edmission stetus . One other provided only type of procedure, end these deteere included only in the total pie.US!302..15Whether inpatient, outpatient, or total, all but about 12-15 percentof ultrasound procedures were abdominal/pelvic, obstetric, or cardiac.Abdominal/pelvic procedures dominated the inpatient procedures (49%), whileabdominal/pelvic and obstetric, between them, accounted for the lion'sshare of outpatient procedures (75%).The procedural mix for inpatients and outpatients, for the GVRHD andother regions of B.C. separately, are shown in detail in Table 6. As inFigure 3, the one facility that provided procedural detail, but not splitinto inpatient and outpatient, is included only in the GVRHD total. Thus,row components for GVRHD do not sum to the total.The data in Table 6 reveal a few regional variations. Whileabdominal/pelvic examinations dominate inpatient procedures inside andoutside the GVRHD, they account for a much larger (62.0%) share in thelatter regions. Furthermore, whereas cardiac procedures are the secondmost common for inpatients hospitalized in the GVRHD, obstetrical scanstake second spot in the rest of the province as a whole.The respective distributions of outpatient procedures also show markeddifferences. The preponderance of abdominal/pelvic and obstetrical is farmore pronounced outside the GVRHD (88.6%) than within (62.5%), thedifference being largely a function of the concentration of cardiacprocedures within the GVRHD. Doppler and ophthalmic exams are presentlyperformed almost exclusively within the GVRHD .16Table 6Number of Ultrasound Procedures, by Geographic Region, Type ofProcedure and Admission Status, 48 Ultrasound Departments,· B.C., 1986InpatientN %OutpatientN %GVRHDTotalN %Abdominal/PelvicObstetricCardiacDopplerEyeOtherTotal10,6233,5837,1881,8676262,66726,55440.013.527.17.02.410.0100.024,43622,85315,1184,4881,9376,88975,72132.330.,85628,44623,6536,4152,70210,664114,73637.424.820. B.C.Abdominal/PelvicObstetricCardiacDopplerEyeOtherTotal11,0853,3742,3329215193317,96761. 718.813.,21927,4604,7594451602,93072,97351.,30430,8347,0915373113,86390,94053.,7086,9579,5201,9597773,60048.815.621.,65550,31319,8774,9332,0979,81941.533.813.,16059,28030,7446,9523,01314,52744.328.814. 44,521 100.0 148,694 100.0 205,676 100.0• 6 of 48 ultrasound facilities had 2 departments providing services,for a total of 54 ultrasound departments. The table includes data forthe 48 ultrasound departments which provided procedural breakdowns forinpatients and outpatients. The figures for one other GVRHD facilitywhich provided only a total procedural breakdown are included in thetotal columns. As a result, under GVRHD and TOTAL, horizontal totalswill not sum correctly.17(c) Obstetrical Ultrasound. Deliveries and Terminated PregnanciesAs in previous years, we were interested in monitoring changes in therates of use of ultrasound in obstetrics. Between 1979 and 1983obstetrical scans per pregnancy (live and still births, abortions, plus allother terminations) had increased from 0.49 to 1.0 (Kinnis and Barer,1986). Once again, gaps in the data made necessary the development of aset of estimation procedures.First, since procedural breakdowns were not provided by nineultrasound departments, estimates were developed for each. While we wouldhave liked to apply the obstetrical share of each department's proceduretotal for 1984 to its 1986 total, the absence of any procedural data forthese departments for 1986 precluded such an approach. Instead, we usedthe much cruder method of applying each department's 1984 obstetrical totalas a proportion of all provincial procedures (whether or not obstetric), tothe 1986 grand procedural total.The assumption implicit in this approach (that each such department'sobstetrical activity remained a constant proportion of all diagnosticultrasound activity in the province) may be questioned. The alternatives,however, were not obvious, as we could not trace each pregnancy back to itsoriginating institution and then construct ratios for only the 42responding institutions.Second, total terminated pregnancies (ectopic pregnancies and othernegative outcomes, abortions; ICD-9 codes 630-637) were not available for1986, although an estimate of 1986 therapeutic abortions in B.C. hospitals18was available from the B.C. Ministry of Health. In order to estimate totalterminated pregnancies in 1986, the ratio of abortions to total terminatedpregnancies was examined for each of the years 1979 to 1983. Using thisrange of ratios, a range of terminated pregnancy estimates was developed.Regional breakdowns were not available, nor were estimates attempted.The results are shown in Table 7. The number of live and stillbirths, which had been increasing slowly between 1979 and 1984, was downmarkedly, from 44,343 in 1984 to 42,121 in 1986, primarily as a result of alarge decrease outside of the GVRHD (from 26,860 to 24,400). Meanwhile, inthe numerator, obstetrical ultrasound procedures were estimated to numberover 67,000, up from 62,638 in 1984. The numbers per reported deliverywere thus up somewhat, from 1.41 in 1984 to 1.59 in 1986 (from 1.70 to 1.75in the GVRHD, and from 1.23 to 1.47 outside the GVRHD).Terminated pregnancies in 1986 were estimated to number between 15,671and 16,113. Obstetrical ultrasound procedures per pregnancy were thenestimated to lie between 1.15 and 1.16 (up from 1.00 in 1983). Thisanalysis suggests that the rate of increase has slowed somewhat. Between1979 and 1983 the ratio was growing 19.5 percent per year. Between 1983and 1986 the rate of growth appears to have been a more moderate 4.8percent annually.4. Staffing(a) Numbers and ProductivityAt December 31, 1986 there were 146 personnel providing ultrasoundservices in the 54 ultrasound departments for which we have this19Table 7Number of Obstetrical Ultrasound Procedures perReported Delivery and per Terminated Pregnancy,58 Ultrasound Departments, B.C., 1986Obstetrical Ultrasound Procedures·Reported Deliveries (Live & Still Births)··Obstetrical Ultrasound Proceduresper Reported DeliveryTerminated Pregnancies:+ MinimumMaximumGVRHD Other B.C. Total31,978 35,928 67,00617,721 24,400 42,1211. 75 1.47 1. 5915,67116,113Reported Deliveries (Live & Still Births)and Terminated Pregnancies:MinimumMaximumObstetrical Ultrasound Proceduresper Reported Delivery andTerminated Pregnancy:MinimumMaximum57,79258,2341.151.16•**+To the known number of obstetrical ultrasound procedures for 49ultrasound departments, have been added estimates for the 9 whichprovided no procedural breakdown. The add-ons were estimated bycalculating each of the 9 departments' 1984 obstetrical procedures asa proportion of the all-procedure total for 1984 (203,521), thenapplying the proportions to the total 1986 procedures (256,758). Seetext for further details.Source: Division of Vital Statistics, Ministry of Health - Annualreports and personal communication.Source: Hospital Programs Inpatient Hospital Discharge and SurgicalDay Care tapes. Terminated pregnancies include the ICD-9 codes 630­637 (ectopic pregnancies and other negative outcomes, spontaneous,legally induced and other abortions). Data not available for 1986 ­minimum and maximum estimated by calculating number of abortions(personal communciation, Hospital Programs) per total terminatedpregnancy for prior years 1979-1984, estimating minimum and maximumproportions for 1986, and applying these to available 1986 abortiondata. Regional breakdowns were not available.20information (Table 8). Included in this figure are 76 fu11- and 29 part­time sonographers, seven fu11- and four part-time students being trainedon-the-job, 10 B.C. Institute of Technology (BCIT) students and nine full ­and 11 part-time radiology technicians providing sonographic services.Counting sonographers and students only, and taking into account the numberof months rooms were open, the number of full-time-equivalent (FTE)sonographers for 1986 was calculated to be 105.0, or 1.1 per FTE room (downfrom 1.2 in 1984). There were 2,103 procedures per FTE sonographer, upfrom 1,970 in 1984. But one should not put too much stock in this apparentdramatic increase in productivity. Slippage either in our estimate of FTEsonographers, or caused by our need to estimate total procedures for thesedepartments, or both, could easily account for all this increase.Conversely, it is at least possible that the slippage resulted in anunderestimate for 1986.The 1984 data for the four non-respondents were examined. The fourfacilities had utilized seven rooms, employed 8.0 FTE sonographers, andindicated they would require an additional 2.0 FTE's within the next twoyears. So, assuming they acquired the additional staff by 1986, anestimated 10.0 FTE sonographers could be added to the above figures toyield 115.0 FTE sonographers, 102.25 FTE rooms, and 1.1 FTE sonographersper FTE room, unchanged from the partial rate calculated above. Proceduresperformed in hospital would increase slightly to 2,119 per FTE sonographer.(b) VacanciesTwenty-six ultrasound departments (48% of 54) reported vacantsonographic positions during 1986. Fourteen (26%) experienced difficulty21Table 8Number of Diagnostic Medical Sonographers,54 Ultrasound Departments, B.C., 1986Total Personnel Providing Services·Estimated Fu11-Time-Equiva1ent (FTE)Sonographers··Estimated FTE Sonographers per FTEUltrasound RoomProcedures Performed in Hospita1+per FTE Sonographer146105 .01.12,103•••+Including full-time and part-time sonographers, students and radiologytechnicians providing sonographic services .For departments opening or closing rooms, estimates of FTEsonographers take into account the number of months the rooms wereopen. The figures include student sonographers being trained on thejob and BCIT students (in 1986, 10 students, 7.3 FTEs).Total procedures by questionnaire for 49 ultrasound departments (Table6) plus HP data for 5 which omitted procedural data(205,676 + 15,161 - 220,837)in recruiting but were able to fill the vacancies, and nine (17%) wereunable to find the required staff.At the same time, from the results of an ongoing survey of essentiallythe same population of hospital facilities in the province, we know that 11actually reported "Di£ficult-to-Fi11" (DTF) vacancies for ultrasonographersin 1986 . 4 This monitoring project has been ongoing since 1980 and consistsof quarterly "spot" counts of the number of vacancies in any health-carerelated field which have been outstanding for one month or more, andactively recruited throughout that period. On the average, there were 5.04 Data received quarterly by the HMRU and stored in a computer-basedfile within the Department.22of these DTF vacancies for ultrasound technologists at any particular timeduring 1986.Recruiting methods described by the fourteen facilities who were ableto recruit, but with difficulty, were "advertising" (36%), "goodconnections" or "good luck" (36%), "re-c1assification of position" (29%),and "on-the-job training" (29%).(c) On-the Job TrainingSeventeen (32%) of 54 ultrasound departments indicated they weretraining their own medical sonographers on -the-job, but 12 of these saidthey would prefer recruiting graduates of a formal medical sonographicprogram (Table 9). Most of the on-the-job training programs were describedas being one year in duration.Continuing education and professional development courses, medicalrounds and lectures, reading and magnetic tape presentations, and on-the­job training were all used to upgrade sonographic skills.(d) Future RequirementsThe 54 ultrasound departments which provided these data indicated theywould require an additional 39.7 FTE sonographers within the next two years(Table 10). The 10 facilities planning to implement ultrasound serviceswould require 7.5 FTE sonographers within the same time period, for a totalof 47 .2 FTE sonographers required within the next two years by BritishColumbia hospitals and diagnostic and treatment centres. Of course, wehave no information regarding private sector recruiting, training, orfuture requirements.23Table 9On-The-Job Training of Medical Sonographers,54 Ultrasound Departments, B.C., 1986"Are you training your own medical sonographers on-the-job?"N %If "Yes":NoYesTotal37175468.531. 5100.0N17Duration of training period: Under 1 year1 year2 years3-4 yearsIndef/No answer"Would you prefer recruiting graduates of aformal medical sonography program?"YesNoNo answerTable 10262251232Future Self-Reported Staffing Requirements, 54 UltrasoundDepartments and 10 Other Facilities, B.C., 1986by Departments Currently by Facilities ExpectingAdditional FTE Providing Ultrasound to Start Providing TotalSonographersto be Added FTE FTE FTEWithin 2 Years Departments Sonographers Facilities Sonographers Sonographers0.0 11 10.3 1 0.3 0.30.4 1 0.4 0.40.5 12 6.0 4 2.0 8.01.0 20 20.0 4 4.0 24.01.5 4 6.0 1 1.5 7 .52.0 1 2.0 2 .02 .5 2 5 .0 5 .0No Info 2Total 54 39.7 10 7.5 47 .2245. Written CommentsTwenty-four of 54 ultrasound departments (44.4%) provided additionalwritten comments on their questionnaires.The general content of the comments is described in Table 11. Amongthe more common themes were the under-supply of medical sonographers, thelack of vacation and sick relief, radiologists and other physicians fillingin, and the need to reduce the workload to cope with staff shortages, etc.(13 respondents). Three agencies suggested there should be a higher wagescale to attract u1trasonographers from private laboratories and fromoutside the province. Two spoke of the difficulty in retaining youngsonographers in rural areas.With regard to training concerns, four respondents described the needfor short, or part-time courses, for radiology technicians wishing toupgrade to medical sonography. Three mentioned the excellence of the BClTprogram, although four others said there should be an increase in thecardiology content.25Table 11Nature of Written Comments Offered Regarding Ultrasound ServiceProvision or Technologist Staffing, 54 Ultrasound Departments, B.C., 1986Nature of CommentsNo commentsOne or more comments:Under-supply of sonographers/no vacation/sick relief/radiologists filling in/workload reduced to copeN3024*13%55.644.4*24.1Need for short/part-time courses,etc., for technologists wishingto upgrade to medical sonographyNeed for higher wage scale toattract sonographersExcellence of BClT programNeed for increased cardiologycontent of ultrasound programDifficulty in retainingsonographers in rural areasProper recognition not givensonographersTotal4 7.43 5.63 5.64 7.42 3.71 1.954 100.0* Numbers below will not add to 24 or 44.4 percent because of multiplecomments offered by some respondents.26SUMMARY1. Fifty-two acute care hospitals (and an unknown number of privatelaboratories) were providing ultrasound services in 1986, up from 49in 1984. Another 10 expected to start providing services by the endof 1988. All but six of the remaining facilities surveyed had fewerthan 30 beds, or were diagnostic and treatment centres .2. There were an average of 2 .0 FTE ultrasound rooms in use per facility.and 1 .8 machines per room.3. We estimated that 256,758 ultrasound procedures were performed in 1986(up from 203,521 in 1984), of which 23 percent were on hospitalinpatients, 72 percent on hospital outpatients, and five percent onprivate laboratory patients. Over 50 percent were performed in theGVRHD.4. On a per capita basis, there were 89 procedures performed per 1000population in 1986 (up from 71 in 1984), 69 of which were foroutpatients. In the GVRHD the rate was 107-117 per 1000 population,while in the rest of B.C. it was 67-75 per 1000 population.5. Inpatient ultrasound procedures per acute care bed numbered about 5 .3,made up of 7.5 within the GVRHD and 3.5 in other regions of theprovince .6. All but 12 percent of procedures were abdominal/pelvic, obstetric. orcardiac. Abdominal/pelvic accounted for 49 percent of inpatientprocedures, while abdominal/pelvic (at 42%) and obstetric (at 34%)dominated outpatient procedures.7 . There were 1.59 obstetrical ultrasound procedures per reporteddelivery in 1986 (up from 1.41 in 1984). In the GVRHD, the rate was1.75 (1.70 in 1984), while in the rest of B.C. it was 1.47 (up from1.23 in 1984).8. Minimum and maximum numbers of terminated pregnancies were estimatedusing 1986 abortion data and previous years' abortion and totalterminated pregnancy data. The number of obstetrical ultrasoundprocedures per pregnancy (deliveries and terminated pregnancies) wasestimated to be about 1.15 in 1986 (up from 1.00 in 1984).9. There were 1.1 FIE sonographers per FTE room (1.2 in 1984), eachperforming 2,103 procedures (up from 1,970 in 1984).10. Fourteen ultrasound departments experienced difficulty in recruitingultrasonographers but were eventually successful, while 9 others wereunable to fill their vacancies during 1986.11. Seventeen ultrasound departments indicated they were training theirown sonographers on-the-job, although 12 of these expressed apreference for recruiting graduates of a formal program .2712. A total of 47.2 FTE sonographers were reported as being requiredwithin the next two years by the 54 ultrasound departments and 10other facilities which provided this information.ReferencesKinnis, C. and Barer, M.L. (1986), Diagnostic Ultrasound in B.C. - 1979 to1984, HMRU Report 86:1, Division of Health Services Research andDevelopment, Office of the Coordinator of Health Sciences, Universityof British Columbia, VancouverAPPENDIX 1Regional Hospital Districts of British Columbia!!II...I IlDIplul DistrIctsI AI"'",I-CII~tI lullloy-lIK...ko] C.pltl'I C.rlboo5 Clfttr.' COlit, Clfttr.' ' ....r '"111}'7 CI.tr.1 IootlnoyI Clfttr.l O....g.n, Col_I.-Shu\w.p10 C_.-St..the_11 C...le .... Yo"IYIZ _ne,-AI_tllU lnt loot.no,II 'r -Chl_IS 'r r-'art....,..6 ,"It.r '.ncou••r11 1It1..t-5tIU..II laohN, _ •.,19 _ftt IIAdd'..t""ZO 11••• 1..Zl Ilorth Ok.nogoftn 0"no9••-5t_lll_I] 'uco Ill..r-ll....ZI '_IlIlI..rZ5 SkHno-Quftft C....lot",Z6 Squ_hh-llll_tZ7 5t1U..II SuMhl.. COlit19 ",-_lIlcollAtltn•27~•'ort _It""23•D..... C..okIFRASER VAllEl)Regional HospilQ/ Dislfiefsof8,,1ish Columbia........1M mlOllS"I CnDZ tulTa&.1 rustl 'ALlUI DkAIlAGAIl5 SDUtM-Wt, 15LAIlD cCIAST7 allTlAl.I lllIIlM CllTlAl., lllIITH•...1_1 IlDIplul DistrIcts .......... ""'It..rll, '"""" by thoIlHlth Ilo_r Reso.rch ""It I._r to ,.,.,,1... lu'flcl..t .....for lnolYll1 of _lIor .._rV""'PI·•Division of Health Services Research &Development


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