UBC Faculty Research and Publications

Diagnostic ultrasound in B.C., 1979 to 1984 Kinnis, Claire; Barer, Morris Lionel 1951- Feb 28, 1986

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DIAGNOSTIC ULTRASOUND IN B.C. HMRU Report 86:1 Division of Health Services Research and Development 1979 TO 1984 ·Office of the Coordinator of Health Sciences The John F . McCreary Health Sciences Centre The University of British Columbia Vancouver, British Columbia V6T 1Z6 Claire Kinnis Morris L. Barer February 1986-ACKNOWLEDGEMENTS The assistance of Ms. Eileen Guiliani, British Columbia Ultrasonographers' Society, and Dr. Peter Cooperberg, Vancouver General Hospital is gratefully acknowledged. This research was supported by the B.C. Ministry of Health. HEALTH MANPOWER RESEARCH UNIT C/O OFFICE or THE COORDINATOR HEAL TH SCIENCES CENTRE PHONE: (604 l 228-4810 Mr. D.S. Haazen Chairman Health Manpower Working ~roup Ministry of Health 1515 Blanshard Street Victoria, B.C. VBW 3C8 Dear Mr. Haazen: 4th FLOOR l.R.C. BUILDING THE UNIVERSITY OF BRITISH COLUMBIA VANCOUVER. B.C., CANADA V6T IZ6 February 19, 1986 It gives me pleasure to submit the report, "Diagnostic Ultrasound in B.C., 1979 to 1984", to the Health Manpower Working Group. This represents the second formal report on diagnostic ultrasound arising out of our five years of data collection. We would welcome any comments you have on the contents of the report, or on future research extensions. MLB:kc Yours sincerely, Morris L. Barer, Ph.D. Associate Director Division of Health Services Research and Development A Research Unit for the Health Manpower Working Group. Ministry of Health. Brilish Columbia TABLE OF CONTENTS Page List of Figures ii List of Tables iii INTRODUCTION 1 I. FACILITIES 1 II. ROOMS AND MACHINES 5 III. PROCEDURES 7 Methods 7 Results 9 IV. STAFFING 18 Staffing Problems, Training Programs and Future Staffing Requirements 20 v. THE PUBLIC/PRIVATE MIX OF ULTRASOUND FACILITIES 21 VI. SUMMARY 21 Appendix 1 Appendix 2 Figure 1 2 3 4 - ii -LIST OF FIGURES Distribution of Ultrasound Capacity Among B.C . Acute Care Facilities, By Size of Facility, 1979 to 1984, Showing Additional Number Expecting to Provide Ultrasound by 1986. Ultrasound Procedures, 1979 to 1984, By Geographic Region Ultrasound Procedures, 1980 to 1984, By Admission Status Ultrasound Procedures, 1979 to 1984, By Procedural Mix 4 11 12 14 Table 1 2 3 4 5 6 - iii -LIST OF TABLES Number of Facilities Surveyed, By Geographic Region and Size of Facility, Showing Number Providing Ultrasound and Number Expected to Within Two Years, B.C. I 1984 Rates of Growth in Ultrasound Capacity, 1979 to 1984 Number of Machines in Use at December 31, 1982 and 1984, By Type of Machine, Showing Number on Order at December 31, 1984 Number of Ultrasound Procedures, By Geographic Region, Procedural Area and Admission Status, 1984 Rates of Growth in the Number of Ultrasound Procedures, 1979 to 1984 Rates of Growth in the Number of Obstetrical Ultrasound Procedures per Reported Delivery, 1979 to 1984, and Per Reported Delivery and Terminated Pregnancy, 1979 to 1983 7 Rates of Growth in the Number of Ultrasound Procedures per Acute Care Bed and per 1,000 Population, 1980 to 1984 8 9 Diagnostic Medical Sonographers in B.C . , 1979 to 1984 Future Self-Reported Staffing Requirements, 1984 2 5 6 9 10 15 17 18 21 INTRODUCTION DIAGNOSTIC ULTRASOUND IN B.C. 1979 TO 1984 Since 1979 the Health Manpower Research Unit has been monitoring the provision and utilization of diagnostic ultrasound facilities in British Columbia. In the past, the method of data collection was through a questionnaire administered to all public general hospitals known or thought to be providing the service. This year (1984), the study population was expanded to include all facilities with rated acute care beds, diagnostic and treatment centres and various private hospitals and clinics, all of which were extracted from the Hospital Programs list of the Ministry of Health, as well as four private practices which were known to be providing the service. Questionnaires were mailed to the survey population, along with return-addressed, stamped envelopes. Second mailings and, in a few cases, telephone calls were utilized to obtain a 100 percent response rate. A copy of the questionnaire appears as Appendix 1. I. FACILITIES The 112 facilities surveyed are displayed in Table l, cross-tabulated by geographic region and size, in terms of rated number of TABLE 1: NUMBER Of FACILITIES SURVEYED, BY GEOGRAPHIC RF.GION AND SIZE OF FACILITY, SHOWING (NUMBER PROVIDING ULTRASOUND) AND [NUMBER EXPECTED TO WITHIN TWO YEARS], B.C., 1984. RATED NUMBER OF ACUTE CARE BEDS1 HMRU RF.GION2 >500 401-500 .J.01-400 201-300 101-200 <100 N/A3 TOTAL -GVRHD 2(2)4 2(2) 3(3) 1( 1) 7(6)( 1]5 2(2) 3(2)( 1] 20( 18)(2] CAPITAL 2(2) 2(1) 1(1) 5(4) FRASER VALLEY 4(4) 2(1)(1] 6(5)(1] OKANAGAN 1( 1) 2(2) 5 1 9(3) SOUTH-EAST 1(1) 16(2)(4] 2 19(3)(4] ISLAND COAST 1( 1) 3(3) 14(3)(1] 1 19(7)( 1] CF.NTRAL 1( 1) 9(2) 2 12(3) NORTH CENTRAL 1(1) 1( 1) 12(4)(1] 2 16(6)( 1] NORTH 5(3)(1] 1 6(3)( 1] TOTAL 2(2) 4(4) 4(4) 4(4) 18( 17)( 1] 67(18)(8] 13(3)(1] 112(52)(10] 1 Approved operating capacity, B.C. Hospital Programs, March 31, 1984. 2 Regional Hospital Districts arbitrarily grouped into 9 regions by the Health Manpower Research Unit (HMRU) -see map in Appendix 2. 3 This group comprises private offices known to provide ultrasound, plus diagnostic and treatment centres, and other such facilities with hQlding beds only, from the Hospital Programs list of the Ministry of Health. 4 Numbers in round brackets provided ultrasound in 1984. 5 Numbers in square brackets expect to provide ultrasound within 2 years of 1984. I "' - 3 -acute care beds. As can be seen, the largest facilities are located in the Greater Vancouver Regional Hospital District (GVRHD) and Capital Region, while many small facilities (100 beds or fewer) are dotted among the South-East, Island Coast and North Central regions of the province (see map - Appendix 2). Table 1 also shows the number of facilities in each region which provided ultrasound in 1984 and the number expecting to within two years. Overall, 52 (46%) of all surveyed facilities were providing the service in 1984, with another 10 (9%) expecting to within two years, that is, by 1986. Although only three (16%) of the 19 facilities in the South-East were providing the service, another four (21%) were expecting to within two years. One hundred percent of facilities in the GVRHD and Fraser Valley provide ultrasound, or will, within two years. Figure 1 illustrates the dramatic increase in the availability of ultrasound services among the smaller acute care facilities since 1979. The largest facilities (over 300 beds) were all providing this service in 1979. In the 101-300 bed groups, complete provision has been reached, or will have been reached, by 1986. In the smallest size group (but the one containing two-thirds of all facilities with acute care beds), provision has increased from four (6%) of 67 facilities in 1979 to 18 (27%) of 67 in 1984 with another eight (12%) expected to offer the service within two years. In total, the Dumber of acute care facilities pr9viding ultrasound has increased from 22 in 1979 to 49 in 1984, representing an average annual rate of growth of 17 percent. The total number of facilities providing ultrasound (acute care 84 80 Figure 1: DISTRIBUTION OF ULTRASOUND CAPACITY AMONG B.C. ACUTE CARE FACILITIES. BY SIZE OF FACILITY. 1979 TO 1984, SHOWING ADDITIONAL NUMBER EXPECTING TO PROVIDE ULTRASOUND BY 1988 Legend ~Ultrasound 88~ .!?~ ... • Ultrasound by 1888 CJ No Ultrasound mAl ~ = 32 u if 28 .... 0 24 ... Q) 20 .c E :J z 16 12 8 4 0 I KM~VVI '''''(''''' ranrrao vgv_vv• '''''{''''' r<r<rrr<r<• >600 401-600 301-400 201-300 101-200 Rated Number of Acute Care Beda <-100 J:-- 5 -facilities and others) increased at an average annual growth rate of 19 percent (from 22 in 1979 to 52 in 1984)(Table 2). II. ROOMS AND MACHINES The number of rooms utilized for ultrasound between 1979 and 1984 grew in line with the increase in the number of providing facilities (Table 2). As a result, the number of rooms utilized per facility increased only slightly. Departments identified for the eight new rooms opened in 1984 were Radiology or X-Ray (5) and Obstetrics, Echocardiography and Ultrasound (1 each). TABLE 2: RATES OF GROWTH IN ULTRASOUND CAPACITY 1979 TO 1984 NUMBER AVERAGE ANNUAL RATE OF 1979 1984 GROWTH{%2 FACILITIES PROVIDING ULTRASOUND 22 52 1 18. 77 ROOMS UTILIZED 38 92 19.34 ROOMS UTILIZED/PROVIDING FACILITY 1. 73 1. 77 0.46 MACHINES UTILIZED 79 187 18.81 MACHINES UTILIZED/PROVIDING FACILITY 3.59 3.60 0.06 MACHINES UTILIZED/ROOM 2.08 2.03 -0.49 • 1 Including 3 facilities with no rated beds The number of machines in use increased from 79 in 1979 to 187 in 1984, representing an annual rate of growth of 19 percent, not appreciably - 6 -different from the rates of growth for rooms and facilities. Machines per providing facility remained unchanged at 3 . 6, while machines per room actually decreased slightly, from 2.1 to 2.0. TABLE 3: NUMBER OF MACHINES IN USE AT DECEMBER 31, 1982 AND 1984, BY TYPE OF MACHINE, SHOWING NUMBER ON ORDER AT DECEMBER 31, 1984 DESCRIPTION OF MACHINE CONVENTIONAL B-SCAN REAL-TIME (LINEAR ARRAY) REAL-TIME (SECTOR FORMAT) INTEGRATED INTO B-SCAN REAL-TIME (LINEAR + SECTOR) + CONVENTIONAL B-SCAN M-MODE (DEDICATED) M-MODE WITH SECTOR ·scAN + REAL-TIME (SECTOR) M-MODE WITH SECTOR SCAN OR LINEAR M-MODE (DEDICATED + SECTOR) + REAL-TIME (SECTOR) M-MODE + REAL-TIME (SECTOR) + PULSE DOPPLER DEDICATED EYE UNITS DOPPLER SMALL PARTS A-MODE TOTAL MACHINES NUMBER IN USE DEC 31/82 N % 41 29.3 19 13.6 47 33.6 1 0.7 10 7.1 9 6 .4 1 0.7 1 0.7 8 5.7 2 1.4 1 0.7 140 100.0 NUMBER IN USE DEC 31/84 N % 43 26 58 5 10 1 6 16 4 5 23.0 13.9 31.0 2.7 5.3 0.5 3.2 8.6 2.1 2.7 3 1. 6 7 3.7 2 1.1 1 0.5 187 100.0 The types of machines in use at the end of 1982 and 1984 are NUMBER ON ORDER DEC 31/84 N % 1 7.1 2 14.3 9 64 .3 1 7.1 1 7 .1 14 100 .0 described in Table 3. Conventional B-Scan, Real-Time (Linear Array) and Real-Time(Sector Format) comprised 68 percent of all machines in use at December 31, 1984, down somewhat from the 76 percent of two years earlier, as more combinations of machine types came into use. Fourteen additional machines were already on order at the end of 1984, mostly (64%) Real-Time (Sector Format) . - 7 -III. PROCEDURES Methods Respondents were asked to provide data on the number of ultrasound procedures performed, broken down into five procedural areas, and inpatient/outpatient mix. They were also asked (1984 only) to indicate if the data were for the calendar or fiscal year. There are resultant problems in estimation, and those pertaining in 1984 are described in the following paragraphs. (i) Twenty facilities provided fiscal and 34 provided calendar year data. For two facilities, each with two separate departments providing ultrasound services, one department reported on a fiscal, the other on a calendar year basis. Two facilities provided no fiscal/calendar information. Of total procedures, 58,813 (29%) refer to the fiscal year, 138,473 (68%) to the calendar, while 6,235 (3%) were unspecified . (ii) For one facility which provided no information, the required data concerning procedures was obtained from the physician fee-item billing data from the Medical Services Plan tapes. These data are different again, being those procedures paid during the fiscal· year. (iii) Five facilities provided totals by procedural area and by the inpatient/outpatient split, but not the detailed cross-classification. Here the total inpatient/outpatient mix was applied to each procedural area total to obtain the required cross-classification (23,554 procedures, 11.6% of total). - 8 -(iv) One facility provided the required data for nine months only. Here, all data were extrapolated linearly to the 12 month period (3,880 procedures, 1.9% of total). (v) Three facilities provided totals by procedural area only. Here, depending on the location of the facility, i.e. GVRHD or other B.C., the respective inpatient/outpatient mix in facilities providing the information was used to obtain the required estimates (17,674 procedures, 8.7% of total). (vi) Three facilities provided the grand total only (one was the number rounded to the nearest thousand). For these, depending again on location, GVRHD or other B. C., the respective procedural mix in facilities providing the information was used to obtain procedural totals, then the respective inpatient/outpatient mix for the appropriate region (GVRHD or other B.C.) was applied to the marginals (6,107 procedures, 3.0% of total). Thus, considering only the last four items above, for about 25 percent of procedures, the figures in the body of Table 4, i.e. the number of each type of procedure done on an inpatient or outpatient basis, are estimates. For about 12 percent of procedures, the inpatient/outpatient totals are estimates. For three percent, the procedural totals are estimates. In earlier years, almost all facilities reported procedural information on a calendar basis, and adjustments similar to those described here were used as necessary to estimate detailed procedural information. - 9 -TABLE 4: NUMBER OF ULTRASOUND PROCEDURES, BY GEOGRAPHIC REGION, PROCEDURAL AREA AND ADMISSION STATUS, 1984 GVRHD PROCEDURAL INPATIENT OUTPATIENT TOTAL --AREA N % N % N % OBSTETRICAL 3,456 11.4 26,274 33.1 29,730 27.1 EYE 299 1.0 2,268 2.9 2,567 2.3 CARDIAC 5,789 19.1 12,092 15.2 17,881 16.3 ABDOMINAL/PELVIC 17,593 58.0 34,603 43.6 52,196 47.6 OTHER 3,199 10.5 4,192 5.3 7,391 6.7 TOTAL 30,336 100.0 79,429 100.0 109,765 100.0 (%) ( 27.6) ( 72.4) (100.0) OTHER B.C. ----OBSTETRICAL 3,896 19.6 29,012 39.3 32,908 35.1 EYE 126 0.6 305 0.4 431 0.5 CARDIAC 2,184 11.0 4,928 6.7 7,112 7.6 ABDOMINAL/PELVIC 12,453 62.8 37,189 50.3 49,642 52.9 OTHER 1,183 6.0 2,480 3.4 3,663 3.9 TOTAL 19,842 100.0 73,914 100.0 93,756 100.0 (%) ( 21.2) ( 78.8) (100.0) TOTAL OBSTETRICAL 7,352 14.7 55,286 36.1 62,638 30.8 EYE 425 0.8 2,573 1. 7 2,998 1.5 CARDIAC 7,973 15.9 17,020 11.1 24,993 12.3 ABDOMINAL/PELVIC 30,046 59.9 71,792 46.8 101,838 50.0 OTHER 4,382 8.7 6,672 4.4 11,054 5.4 TOTAL 50,178 100.0 153,343 100.0 203,521 100.0 (%) ( 24.7) (75.3) (100.0) Results There were almost 204,000 ultrasound procedures performed in 1984 in B.C., 25 percent on inpatients and 75 percent on outpatients (Table 4). Almost one-third of the total were obstetrical and one-half abdominal/pelvic. There were 109,765 (54%) procedures performed in the GVRHD and 93,756 (46%) in - 10 -other regions of the province. Over the period 1979 to 1984, total procedures grew in number from 69,487 to 203,521, representing an annual growth rate of 24 percent (Table 5). TABLE 5: RATES OF GROWTH IN THE NUMBER OF ULTRASOUND PROCEDURES 1979 TO 1984 AVERAGE ANNUAL NUMBER RATE OF 1979 1984 GROWTH (%) TOTAL PROCEDURES 69,487 203,521 23.98 HMRU REGION: GVRHD 42,931 109,765 20.65 OTHER B.C. 26,556 93,756 28.70 PROCEDURAL MIX: OBSTETRICAL 27,784 62,638 17.65 EYE 836 2,998 29.10 CARDIAC 9,873 24,993 20 .41 OTHER 30,994 112,892 29.50 (ABDOMINAL/PELVIC) (56,231) 1 (101,838) (21.89) (OTHER) ( 4,246) 1 ( 11,054) (37 . 57) 1 These are 1981 figures. Commencing that year "Other" was broken down into "Abdominal/Pelvic" and "Other". Rate of growth calculated 1981 to 1984. The breakdown by geographic region over the years 1979 to 1984 is displayed in Figure 2. A gradual shift from GVRHD to other B.C. is apparent, a result of the continued dispersion of the technology to the smaller rural hospitals. The annual rate of growth for GVRHD has been 21 percent (from 42,931 in 1979 to 109,765 in 1984), compared to 29 percent for other B.C. (from 26,556 to 93,756) (Table 5). The annual rate of growth for inpatient procedures has been 17 percent, compared to 21 percent for outpatients (Figure 3) over the period Rgure 2: ULTRASOUND PROCEDURES, 1979 TO 1984, BY GEOGRAPHIC REGION ., om ac: ";: en. :::t:-, ~.I ~ 11982 ~ 11981 ~ 11980 ~ 11979 1884 Geographic Region tz2I GVRHD CJ Other B.C. I - ..------- - ---.- --------.--- 1------.----------.--- --------.-----1 -- T - I 0 60 100 160 200 260 Thousands of Procedures ..... ..... ., om cc"C: Cl). %.., Figure 3: ULTRASOUND PROCEDURES, 19801 TO 1984. BY ADMISSION STATUS w. 11984 - 11982 • I 1aa1 ~ I 1980 Admission Status IZ2I Inpatient CJ Outpatient --1 0 60"' 100 160 200 260 Thousands of Procedures 'Ad111l11lon 1tatu1 data not avallable for 1979 • ...... N - 13 -1980 to 1984 (1979 data not available). Thus, outpatient procedure growth has exceeded that for inpatients, resulting in outpatient procedures representing 75% of all procedures in 1984, in contrast to about 72% in 1980. Procedural mix is displayed in Figure 4 (and reported in Table S). Obstetrical and cardiac procedures increased proportionately less than others, at annual growth rates of 18 and 20 percent, respectively. Abdominal/pelvic were separated out from "Other", commencing in 1981. These have since increased at an annual rate of growth of 22 percent, and in 1984 comprised SO percent of all procedures. In Table 6 we focus more closely on the relationship between obstetrical ultrasound services, and the target population. An 'ideal' denominator would be number of pregnancies during the period of interest, adjusted perhaps for relative ultrasound use by trimester and mix of pregnancies by trimester. In the absence of this sort of detail, we developed a denominator embodying all still and live births, plus all other terminated pregnancies reported from acute care and day care facilities in the province. Terminated pregnancies included any discharge record showing an ICD-9 code of 630.0 - 637.9. Table 6 is divided into two sections. The first covers the entire period 1979 to 1984, but relates obstetrical ultrasound procedures to a denominator of births only. The second half of the table contains data for 1979 and 1983, related to the denominator of all terminated pregnancies (whether by birth or abortion). The split of terminated pregnancies between GVRHD and the rest of the province is an estimate, based on the average ratio of GVRHD/total B. C. for the period 1979 to 1982. This series ends in 1983 because we did not have data on Figure 4: ULTRASOUND PROCEDURES, 1979 TO 1984, BY PROCEDURAL MIX CD QCD a:~ Cl). :c-, ~ Abd/Pelvlo I 11884 -- Abd/Pelvlc 111882 ~ Abd/Pelvlc 11 1881 ~ 11880 - 11878 r Procedures IZ2J Obstetric •Eye ~Cardiac D Other 0 60 100 160 200 260 Thousands of Procedures ...... ~ I - 15 -TABLE 6: RATES OF GROWTH IN THE NUMBER OF OBSTETRICAL ULTRASOUND PROCEDURES PER REPORTED DELIVERY, 1979 TO 1984, AND PER REPORTED DELIVERY AND TERMINATED PREGNANCY, 1979 TO 1983 NUMBER 1979 1984 AVERAGE ANNUAL RATE OF GROWTH % OBSTETRICAL ULTRASOUND PROCEDURES: 27,784 14,992 12,792 62,638 29,730 32,908 17.65 14.67 20.80 GVHRD OTHER B.C. REPORTED DELIVERIES (LIVE & STILL BIRTHS) 1 : 38,730 14,608 24,122 44,343 17,483 26,860 2.74 3.66 2.17 GVRHD OTHER B.C. OBSTETRICAL ULTRASOUND PROCEDURES PER REPORTED DELIVERY: o. 72 1.41 14.39 10.54 18.34 GVRHD OTHER B.C. 1.03 0.53 1979 1. 70 1.23 1983 OBSTETRICAL ULTRASOUND PROCEDURES: 27,784 60,000 2 21. 22 16.38 26.25 GVRHD OTHER B.C. 14,992 12,792 27,500 2 32,5002 REPORTED DELIVERIES (LIVE & STILL BIRTHS) AND ABORTIONS3: 56,499 59,920 1.48 1.38 1.55 GVRHD OTHER B.C. 23' 777 32,722 25,115 4 34,805 4 OBSTETRICAL ULTRASOUND PROCEDURES PER REPORTED DELIVERY AND ABORTION: 0.49 1.00 19.52 14.69 24.27 1 2 3 4 GVRHD OTHER B.C. 0.63 0.39 1.09 0.93 Source: Division of Vital Statistics, Ministry of Health - Annual reports and personal communication. Data estimated graphically from the available data collected for 1979 to 1982 and 1984. Source: Hospital Programs Inpatient Hospital Discharge and Surgical Day Care tapes. Abortion data are for the fiscal years 1979-80 and 1983-84, and include ICD-9 codes 630-37 (ectopic pregnancies and other negative outcomes, spontaneous, legally induced and other abortions. 1984-85 data are not available at time of writing. Regional breakdown for abortion data included in these figures not available. Estimates based on average percentages occurring in the previous 4 years (51.3% GVRHD). - 16 -abortions for the 1984/85 fiscal year at the time of writing. But the data problems did not end there. Biennial data collection meant we had no data on ultrasound procedures for 1983. The points for 1979, 1980, 1981, 1982 and 1984, for each of GVRHD and the total province, were plotted, a smooth curve drawn, and a 1983 estimate , based on non-linear eye-ball interpolation, obtained for Table 6. Subject to these data problems, none of which seemed major, we find that current rates of obstetrical ultrasound provision are now (1983) averaging one per pregnancy, up from one for every two pregnancies four years earlier. Growth has been even faster in the regions of the province other than GVRHD, consistent with the expanding capacity elsewhere in the province. It would appear that obstetrical ultrasound is becoming a routine procedure, although it would take considerably more research to determine the per pregnancy distribution of services. Of course number of births. may be an appropriate denominator, if ultrasound is less often a procedure associated with abo~tion. But in the absence of distributional data by trimester and outcome, one can only speculate . Using births only as a denominator yields a slightly slower rate of growth (14.4% vs. 19.5%) over the longer period (1979-1984). - 17 -Ultrasound procedures increased from 36.4 to 71.1 per 1,000 population between 1980 and 1984 (Table 7), for an annual average rate of growth of 18 percent per capita (data for 1979 are incomplete; therefore, for comparison purposes in this segment, only the period 1980 to 1984 is discussed). The GVRHD rate increased somewhat less rapidly than that of the rest of the province, as did the inpatient compared to the outpatient rate. TABLE 7: RATES OF GROWTH IN THE NUMBER OF ULTRASOUND PROCEDURES PER ACUTE CARE BED AND PER 1,000 POPULATION, 1980 1 TO 1984 ULTRASOUND PROCEDURES PER 1,000 POPULATION: GVRHD2 OTHER B.c.2 INPATIENTS OUTPATIENTS INPATIENT ULTRASOUND PROCEDURES PER ACUTE CARE BED: GVRHD2 OTHER B.C. 2 INPATIENT ULTRASOUND PROCEDURES PER ACUTE CARE BED, FOR FACILITIES PROVIDING ULTRASOUND: GVRHD2 OTHER B.C. 2 1 Data incomplete for 1979 NUMBER 1980 36.4 50.5 25.8 10.1 26.3 2.27 3.36 1.38 3.15 3.78 2.38 1984 71.1 90.3 57.0 17.5 53.6 4.57 6.23 3.25 5.24 6.48 4.06 AVERAGE ANNUAL RATE OF GROWTH (%) 18.22 15.64 21. 92 14.73 19:48 19.12 16.69 23.88 13.57 14.42 14.28 2 Region is that of the facility providing the service, not necessarily that where the patient resides. Thus, these figures are services provided in each region, to whomever, divided by the population or bed capacity of the region. Inpatient ultrasound procedures per acute care bed increased from 2.27 to 4.57 in the same period of time, for an average rate of change per - 18 -annum of 19 percent. As in the per capita rates, the rate for other B.C. increased more steeply than did that of the GVRHD. However, when the beds for facilities not providing ultrasound are removed from the denominators, ·the rates of change stabilize at 14 percent for all regions of the province. IV. STAFFING Table 8 provides information on the number and estimated productivity of diagnostic medical sonographers over the period 1979 to 1984. The number of personnel providing ultrasound services has more than doubled since 1979; 139 individuals provided at least some service during 1984. This includes 103 full-time-equivalent sonographers, again over double the number in 1979. The TABLE 8: DIAGNOSTIC MEDICAL SONOGRAPHERS IN B.C. 1979 TO 1984 1979 1980 1981 1982 Total Personnel 1 Providing Service 62 79 91 103 Estimated Full-Time Equivalent (FTE) 46.1 58.6 67.8 77.8 Sonographers 2 Estimated FTE Sonographers: 1.3 1.3 1.3 1.2 per FTE Ultrasound Room Procedures per FTE Sonographer 1507 1669 1777 2044 1984 139 103.3 1.2 1970 1 Including full-time and part-time ultrasonographers, students, radiology technicians and radiographers providing sonographic services . Information on others providing the service (radiology technicians, radiographers, etc.) not requested in 1979. ·2 For calculation of FTE's, for facilities opening or closing rooms, estimates of full-time-equivalents take into account the number of months the rooms were open . The figures include student sonographers being trained on the job and BCIT students. The BCIT program commenced in 1980 with 8 students (5.9 FTE's), increasing to 10 (7.3 FTE's) in 1984. - 19 -rate of growth of f .t.e. sonographers has stayed even with that of personnel with any involvement, the persons/f.t.e. sonographers ratio remaining at about 1.34 throughout 1979 to 1984. Eighty-five full-time and 22 part-time ultrasonographers, 17 students (7 on-the-job and 10 BCIT), nine radiology technicians and six radiologists provided ultrasound services in 1984. The BCIT program commenced in 1980 with eight students, increasing to ten in 1983. Students spend two days a week for four months, then four and one half days a week for eight months, at seven participating hospitals. The data in Table 8 also suggest that staffing per ultrasound room has remained stable, at 1.2 to 1.3 full-time-equivalent sonographers per room. But the service provision, or productivity, of the average full-time sonographer has apparently increased substantially, and seems to be levelling off at about 2000 procedures per year. Of course one cannot tell from these data whether this reflects a true productivity increase, as sonographers become more familiar with procedures and patient loads increase, or whether it reflects capital equipment enhancements (improving machine rather than human productivity) or changes in the mix of procedures being performed. Figure 4 suggested some changes in the latter, but these data alone do not provide information on possible variations in sonographer time requirements for different procedural sites. - 20 -Staffing Problems, Training Programs and Future Staffing Requirements The responses of 58 respondents are reported in this section (52 facilities with ultrasound plus six for the six of these with two departments providing the service). There were 18 reports of vacant technician positions sometime during 1984. In five of these the positions could not be filled; in the other 13 the positions could be filled, but with difficulty in eight. Of the latter, three recruited from outside the province and one from Great Britain. One waited for a graduate of BCIT, one changed the union status of the position, one gave up (the radiologist does the scans) and one provided no information. There were 10 reported on-the-job training programs for ultrasound technicians in 1984, one of three months duration, one of eight months, five of one year, and three of two years. Forty-six (79%) of the 58 respondents indicated a preference for graduates of a formal-training program. Six were providing a clinical site for students from the BCIT program, three for one student, one for two students and two for three students, 11 students in all. Future staffing requirements are displayed in Table 9. Facilities currently providing ultrasound indicated they would require an additional 27.5 f.t.e. ultrasonographers within the next two years; the 10 facilities expecting to start ultrasound by 1986 indicated they would require 9.3 f.t.e.'s, for a total of 36.8 f.t.e. ultrasonographers. - 21 -TABLE 9: FUTURE SELF-REPORTED STAFFING REQUIREMENTS, 1984 ADDITIONAL FTE TECHNICIANS TO BE ADDED WITHIN 2 YEARS 0.0 0 . 5 1.0 1.3 1. 5 2.0 3.0 No Info TOTAL BY FACILITIES CURRENTLY BY FACILITIES EXPECTING PROVIDING ULTRASOUND TO START PROVIDING ---FTE FTE Facilities Technicians Facilities Technicians 23 17 8.5 5 2.5 11 11.0 1 1.0 1 1.3 2 3.0 3 4.5 1 2.0 1 3 . 0 3 58 1 27 . 5 10 .9. 3 TOTAL FTE TECHNICIANS 11.0 12.0 1. 3 7 . 5 2.0 3.0 36.8 1 6 of the 52 facilities providing ultrasound had 2 departments providing the service, for a total of 58 employing departments. V. THE PUBLIC/PRIVATE MIX OF ULTRASOUND FACILITIES Prior to 1982, all diagnostic ultrasound in the province was provided out of public general hospitals. There were three private clinics offering this service in 1984, and one other indicated that it would be doing so within two years. There may be others with intent about which we have no current knowledge. About 2.5 percent of all procedures provided in 1984 were provided by the three private facilities. VI. SUMMARY This makes the fifth year that the Health Manpower Research Unit has solicited information on diagnostic ultrasound from provider institutions or agencies. The report provides a brief look at five year trends in provision - 22 -volume and mix, as well as a focus on 1984/85. Key findings were as follows: 1) Forty-nine acute care hospitals and three private practices were providing ultrasound services in 1984, up from 22 acute care hospitals in 1979. All facilities with 300 or more acute care beds will likely be providing ultrasound by 1986. 2) The number of rooms and machines in use grew in line with the number of providing facilities, at an average annual growth rate of 19 percent over the five years 1979 to 1984. 3) Between 1979 'and 1984, total ultrasound procedures increased at an average annual rate of 24 percent, from 69,487 to 203,521. Non-GVRHD growth has exceeded that of the GVRHD, and outpatient procedure growth has exceeded that for inpatients. 4) In 1984, 75 percent of procedures were performed on outpatients, and 54 percent in GVRHD facilities. One-third of procedures were obstetrical and one-half were abdominal/pelvic. 5) Rates of obstetrical ultrasound provision were in 1983 averaging one per pregnancy, up from one for every two pregnancies in 1979, with the rate of growth being even faster in non-GVRHD regions of the province than in the GVRHD. 6) There were 71 ultrasound procedures per 1000 population and 4 . 6 inpatient procedures per acute care bed in 1984, representing five year annual average rates of growth of 18 and 19 percent, respectively. - 23 -7) The number of personnel providing ultrasound services has more than doubled since 1979, to 139 individuals in 1984 - 85 full-time and 22 part-time ultrasonographers, seven on-the-job and ten BCIT students, nine radiology technicians and six radiologists. 8) It appears that staffing per ultrasound room has remained stable, at 1.2 to 1.3 f.t.e. sonographers per room. Apparent productivity of the average full-time sonographer has increased substantially since 1979, but may have levelled off to about 2000 procedures per year. 9) There were 18 vacant technician positions reported during 1984; five could not be filled, and of those filled, eight facilities reported recruiting difficulties. 10) Facilities currently providing ultrasound indicated they would require an additional 27.5 f.t.e. ultrasonographers by 1986. Ten facilities expecting to start ultrasound by 1986 indicated they would require 9.3 sonographers initially. APPENDIX 1 QUESTIONNAIRE I. GENERAL INFORMATION 1. Name of Hospital or Group ULTRASOUND SERVICES QUESTIONNAIRE 1984 2. Name of Respondent -------------------------------3. Position of Respondent-------------------- Phone-------II. ULTRASOUND FACILITIES 4. Does your hospital or group have one or 110re ultrasound rooms which were in use during all or part of 1984? YES D NOD If NO, please proceed to Question 12b. If YES: How many?-------Please indicate changes which occurred in 1984 in the number or departmental location (ff hospital-based) of ultrasound rooms: New Rooms Rooms which ceased operations Department Opened in wM ch month during 1984 5. Please indicate the number of each of the following types of machines utilized by your hospital or group as of December 31, 1984, and on order as of that date: (a) (b) (c) (d) (e) ( f) (g) Conventional 8-scan Real-time (linear Array) Real-time (Sector Format) M-mode (Dedicated) M-mode with Sector Scan Dedicated eye units Other; Pl•••• •pecify: Number Utilized as of Dec. 31, 1984 Number on Order as of Dec. 31, 1984 ( •••• continued) -2-III. ULTRASOUND UTILIZATION 6. (a) Please indicate the number of procedures undertaken during the 1984 calendar year .er.during the 1984-85 fiscal year* in each of the following areas: Inpatient Outpatient (i) Obstetrical (11) Abdominal and pelvic (iii) Eye (iv) Cardiac ( v) Doppler (vi) Other (Pl•••• •peclfuJ TOTAL *Please check one: Data are for: Calendar Year 1984 § Fiscal Year 1984-85 (April 1/84 - March 31/85) Other (Pleue •peci.f11J ________ _ IV. CURRENT STAFFING FOR ULTRASOUND 7. Please indicate the number of physicians, on average, who worked (part-time or full-time) in your ultra-sound room(s) during 1984: * 8. Radiologists Cardiologists Obstetricians Other (Please specif11J ---------Average S of their working time spent in Ultrasound* Total time spent in ultrasound by all physicians in each category (e.g. Radiologists) divided by total working time of the same physicians. How many of each of the following types of personnel 'were providing 'ultrasound technician' services in your hospital or group as of December 31, 1984. * ** Ultrasound technicians Student technicians** Other (Please Speci.f11J Number of Full-time Nllllber of Part-time Time spent in ultrasound divided by total working time. Average S of time spent in Ultrasound by part-time techni ci anS'* Currently being trained as diagnostic medical sonographers, formally or on-the-job. ( •••• continued) -3-IV. CURRENT STAFFING FOR ULTRASOUND (continued) 9. (a) Did you have vacant technician positions associated with your ultrasound facilities during 1984? YES D NO D (b) lf YES, were you able to fill these vacancies? YES D NOD (c) lf YES, in (b), did you have al'\Y difficulty recruiting experienced ultrasound technicians to 1lT1 these vacancies? YES D NOD (d) If YES, in (c), how did you resolve this difficulty? 10. (a) If you are training your own ultrasound technicians •on-the-job', what is'the duration of their training period? (b) Would you prefer recruiting graduates of a fol"lllll ultrasound technician program? YES D NU D 11. (a) Are you providing a clinical site for students from the BCIT ultrasound technician program? YES D NOD (b) If YES, for how many students? __ V. FUTURE STAFFING REQUIREMENTS FOR ULTRASOUND 12. Please answer either (a) or (b). (a) If YOUR HOSPITAL OR GROUP CURRENTLY HAS ONE OR MORE ULTRASOUND ROOMS: How 111ny technicians do you foresee a need to add (or subtract) to your ultrasound room(s) staff within the next TWO years? (count part-time technicians as~. do not include replacement staff; and indicate 11dd' by '+', 'subtract' by '-',e.g.+ 2.5). _____ _ or (b) IF YOUR HOSPITAL PLANS TO START ITS FIRST ULTRASOUND ROOM WITHIN THE NEXT TWO YEARS: How many .-technicians do you anticipate needing to adequately staff the room? (count part-time technicians IS ~). VI. COMMENTS 13. If you have any further c011111ents regarding ultrasound service provision or ultrasound technician staffing, please let us know. We would be particularly interested in hearing of relative strengths of technicians coming from different training backgrounds, staffing problems you 1111y be encountering in ultrasound, etc. (please use additional pages as necessary). ( •••• continued) APPENDIX 2 MAP OF B.C. !n!wl llDspltll pt1trlcy ' .,..,.,-c:,.,..., i ~~~::r ...... 4 Carl-l Cetitr1 I Collt I Cotltr1I fr11llr' t111., 1 C1atr1I loOllMJ I Cotltr1I lllllMll• ' Col-11-Slloo-• to C-•-Strotllc--11 Cawtc.,.. f1l11.r II llolldae7-Al-tt.t 1J (Ht loOltM.J " frllllr'-0..-ll Fr111f'-fort '""91 ll &rHtllr' l1acau-l1 lttlMt-StlUM II S.tet111-'7 " -t lllOdlftllGll 211 ...... ZI llDrtll lllllMllft ZZ Clll1Mg1a-Sl•I .. _ ZJ ·-· 11--l!Ull Z4 •-11 ....... n 5'Ht11-qu.. C11orl1tt1 ZI 5qMlml1ll-Llllwt Z1 StlUM ZI SllMhlftl Colt& zt ........... 1e111 AUi• • 27 • hrt ...... 23 • O-•'"" IFRASER YAIIl!J R1giona/ Hospild Dislticts of Brilisll Columbia .!!!!!!.Y-1" 1£&1DllS9 "8 I CAPITM. J FUSll WM.I.Ff 4 OUUGM I SIUJll-WT I lKMI CllA5T 1 CDTRAI. I llllTll tEllUl ' Diii •..,._, llllpltll ltstrtcu ...,. - utlttrorll.r .,..... 111J U. llNltll ... _.. lesellr'Cll llll!t ,. ..... to prwtd8 suff!cl .. t .... fw Mllfltl •f -""" -..-. & nt .. .a • .a .... -s u-·'•~ ., ____ .. ___ " ·-· .. ,. .._. - ·· . .... - .. .. 

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