Out-of-hours radiology: a suitable case for audit?

An outline of radiological activity outside normal working hours over a 2-month period in a teaching hospital is presented. A 100-fold variation between specialties in the number of requests per 100 discharges and deaths is shown. Specialties with a high out-of-hours radiology demand also tended to have a high overall demand. Chest and abdomen radiographs accounted for approximately 82% of all investigations undertaken during the period of observation. Six radiological investigations--chest and abdomen radiographs, computed tomography, skull radiographs, intravenous urography and cardiac catheterisation--accounted for approximately 94% of all out-of-hours investigations. There was a 5.6-fold variation between investigations in the time taken to carry out one standard unit of work. In the health authority studied, it was estimated that pounds 93,000 was spent on radiographers' out-of-hours payments in 1984/85, of which almost 90% was directly related to the number of radiological procedures undertaken. It is suggested that the wide variation in rates of out-of-hours radiology usage between specialties requires more detailed examination. The limited range of procedures accounting for the great majority of the out-of-hours work makes a study feasible. The very marked variation in the time taken for one unit of work may result in important financial distortions if clinical budgeting becomes more widespread. The large excess cost of out-of-hours radiological investigations, which may be as much as pounds 16,000,000 per annum in England and Wales, offers the possibility of substantial savings if some of the investigations are shown to be of little clinical value outside normal working hours.