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 m any people does it take to operate a picture archiving and communication sy stem (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 re sponse for routine services, we found that including the Intensive Care Uni ts (ICUs) increased our demand for urgent response beyond our capacity. The addition of inpatient bedside imaging to PACS also increased the demand fo r round-the-clock and weekend PACS services. Our answer to the staffing que stion changes every year, in accordance with changes in the scope of servic es that our PACS is expected to provide. Our administration drew up a 5-yea r plan for PACS implementation, concentrating on purchase and installation of equipment, but neglected to estimate requirements for full-time equivale nts (FTEs) for PACS. Our administration reasonably assumed that existing em ployees would be galvanized into PACS personnel. It is now clear that new F TEs need to be created strictly for the PACS service. Our B-year plan also did not anticipate significant changes in the extent of our healthcare ente rprise. Our PACS accommodates limited remote service: providing a PACS Anal yst to travel to the site when a problem is not resolved remotely is anothe r demand on staffing. Our PACS service was formed using staffing numbers ba sed 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 long standing problems. This staffing was based on a single shift operation, wit h on-call coverage for second, third, and weekend shifts. The number of emp loyees 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 appropr iately by Human Resources, without excluding potentially desirable applican ts. In addition to competitive pay, other factors play an important role in recruiting and retention. These include training that the hospital provide s, opportunities for advancement, relief from menial duties, adequate worki ng space end facilities, and opportunities for self-development. There is h igh turnover of personnel in computer services, and we are in a highly comp etitive 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 o ccupied by "greenhorns." In our case, where the vendor provides on-site ser vice engineers, we are able to operate with fewer FTEs. The more distant an d 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 reduc ing the number of FTEs. Instead of adding PACS responsibilities to supervis ors of imaging services, we are creating new PACS FTEs outside the PACS ser vice. The idea is to give imaging supervisors the assets they need to perfo rm the additional tasks involving PACS, such as first-line response to trou ble, user training, and quality-control oversight. It also frees up PACS se rvice personnel to deal with training and problems with customers outside t he Radiology Department. Copyright (C) 2001 by W.B. Saunders Company.