Safety of working patterns among UK neuroradiologists: A comparison with the aviation industry
Dr J Reicher, Dr S Currie, Dr D Birchall
•Radiologists’ workload is steadily increasing as the number of new Consultants fails to match the increasing volume of imaging1.
•Studies show that radiologists' performance is reduced at the end of a full day of reporting2,3,4.
•Yet there is limited guidance for radiologists about structuring working days to strike the balance between achieving satisfactory reporting volume and maintaining quality.
•Many areas of medicine have looked to the more tightly regulated aviation industry for lessons in optimising patient safety, for example in the development of the WHO surgical safety checklist5.
•There are striking similarities between the work of radiologists and of Air Traffic Controllers (ATCs) – both are largely screen-based, cognitively demanding, and crucial to others (pilots/clinicians) operating safely.
•To ascertain current practices among neuroradiologists.
•To compare with professionals (ATCs) from the more tightly regulated aviation industry.
•To encourage a conversation among radiologists and their managers about safe working practices.
•Email survey of 86 UK Neuroradiologists (59 responses) about duration of reporting sessions, frequency and duration of work breaks.
•Interview of ATCs from our local International Airport .
Research into the legislation which governs ATCs working hours, and the literature on which this is based.
Comparison with the air traffic controllers
•Strict legislation from the Civil Aviation Authority controls working hours for ATCs in the UK. Working days for ATCs are legally limited to 8 hrs (vs 40% surveyed neuroradiologists reporting for >8hrs in one day) .
•ATCs must take a break after 2 hours of work vs 20% of neuroradiologists reporting for 2.5 hrs or more before a break
•Breaks legally must be a minimum of 30 minutes (only 14% of neuroradiologist’s breaks are 30mins or more)
•Specific instructions in the legislation6 about what ATCs’ breaks should consist of to optimise cognitive performance, emphasising detachment from work tasks. 46% of neuroradiologists’ breaks consist of screen-based administrative tasks (emails etc) and 15% consist of cognitively demanding work, eg registrar teaching or consultations with clinical colleagues
•Experimental psychology has established that cognitive performance decreases after as little as 20-30 minutes on a particular task, and also that taking regular breaks and switching between different tasks protects against such performance decrements7.
•In contrast with their counterparts in Air Traffic Control, many surveyed neuroradiologists work long reporting days, with rare and short breaks. When breaks are taken, they often involve screen-based and/or cognitively demanding activities.
•Although we surveyed neuroradiologists specifically, we anticipate that the results are likely to apply to general radiologists as well.
•Radiologists, like air traffic controllers, are reliant on optimal cognitive performance, to produce high-quality, safe reports for patients.
•Other areas of medicine have learned from the aviation industry and innovated accordingly and we feel there are important lessons here for the radiology workforce
•In the current climate of increasing radiology workloads, there is an urgent need for more guidance for both radiologists and their managers, in terms of structuring the working day to ensure safe reporting practices.
•With thanks to Dr Steven McKinstry, who first suggested to the authors the parallels between radiology and air traffic control