How many people does it take to operate a picture archiving and communication system?
The most frequently asked question without a correct answer is: "Just how many people does it take to operate a picture archiving and communication system (PACS)?" At Texas Children's Hospital, our consensus is that we do not yet know. As soon as we felt we had adequate staffing to provide timely response for routine services, we found that including the Intensive Care Units (ICUs) increased our demand for urgent response beyond our capacity. The addition of inpatient bedside imaging to PACS also increased the demand for round-the-clock and weekend PACS services. Our answer to the staffing question changes every year, in accordance with changes in the scope of services that our PACS is expected to provide. Our administration drew up a 5-year plan for PACS implementation, concentrating on purchase and installation of equipment, but neglected to estimate requirements for full-time equivalents (FTEs) for PACS. Our administration reasonably assumed that existing employees would be galvanized into PACS personnel. It is now clear that new FTEs need to be created strictly for the PACS service. Our 5-year plan also did not anticipate significant changes in the extent of our healthcare enterprise. Our PACS accommodates limited remote service: providing a PACS Analyst to travel to the site when a problem is not resolved remotely is another demand on staffing. Our PACS service was formed using staffing numbers based on assumptions about the minimum number of employees needed to perform routine duties, field trouble calls, conduct training, and work on special projects, such as adding new acquisition modalities or troubleshooting longstanding problems. This staffing was based on a single shift operation, with on-call coverage for second, third, and weekend shifts. The number of employees also considered absences for vacation, sick leave, and training. The service has administrative overhead that should be covered by a secretary. Someone is also needed to supervise the team. Once the number of personnel is determined, detailed definition of qualifications and responsibilities is required. Each job description must accurately reflect what is expected of the employee, but must be constructed in such a way to be graded appropriately by Human Resources, without excluding potentially desirable applicants. In addition to competitive pay, other factors play an important role in recruiting and retention. These include training that the hospital provides, opportunities for advancement, relief from menial duties, adequate working space and facilities, and opportunities for self-development. There is high turnover of personnel in computer services, and we are in a highly competitive market. The correct number of FTEs must consider that we will have to operate the PACS during periods when one or more positions are open or occupied by "greenhorns." In our case, where the vendor provides on-site service engineers, we are able to operate with fewer FTEs. The more distant and tenuous our vendor support, the more we would need to depend on hospital FTEs. While remote vendor maintenance is helpful, it is not useful in reducing the number of FTEs. Instead of adding PACS responsibilities to supervisors of imaging services, we are creating new PACS FTEs outside the PACS service. The idea is to give imaging supervisors the assets they need to perform the additional tasks involving PACS, such as first-line response to trouble, user training, and quality-control oversight. It also frees up PACS service personnel to deal with training and problems with customers outside the Radiology Department.