One CT Scanner Down for Three Weeks

Size it before you negotiate it. Normal capacity is about 168 scans per day across two scanners (42,000 ÷ 250). With one scanner you have roughly 84 slots per day unless you extend hours. Extending the working scanner from 8 to 16 hours with staggered technologist shifts recovers perhaps 25–35 percent more slot time - call it 105–110 studies per day - so you are still short of demand by roughly 55–60 studies per day, and the 640-study backlog grows by that much daily unless demand is redirected. That arithmetic is the argument you take to finance, not a description of how busy everyone feels.

Triage rules, published in writing:

1. ED and inpatient studies first, in the order the requesting clinician flags as urgent; this was already promised in writing and is not negotiable.
2. Time-critical outpatients next - oncology staging and treatment-response scans, preoperative studies for scheduled surgery, suspected PE or fracture follow-up outside the ED.
3. Routine outpatients last, with active redirection.

Redirection is a decision, not a failure. Identify which studies can be safely moved to a partner site or the competitor and offer to schedule and transmit there at no penalty to the patient, particularly for the two referring groups already sending volume elsewhere. Losing a scan to a partner under an agreement you control is better than losing the referring relationship entirely.

Cut the 18 percent no-show rate now - reminder calls at 48 and 24 hours, a confirmed waitlist that fills same-day cancellations, and a policy that a second no-show requires re-referral. Every recovered slot is capacity you already paid for.

Do not spend unapproved overtime and do not let the scanner sit idle - both are failures, and the second is worse.

Within your authority, immediately:

• Convert the working scanner to extended hours using voluntary shift changes and existing per-diem or float technologists before adding overtime hours.
• Ask the two technologists on leave whether either wants partial voluntary hours; ask, do not pressure.
• Request temporary coverage through a staffing agency or a sister facility's pool - pre-approved contract labor is often a different approval path than overtime, and it may be faster.
• Move non-scanning tasks (registration, protocol questions, screening forms) off technologist time so the scanner keeps turning.
• Stagger read prioritization with radiology so outpatient reports release in the order patients were scanned; a 14-hour read backlog with a 38-minute scan turnaround suggests the constraint has moved downstream.

Escalate in writing, on day one, not day nine. Send the regional director's backup and the finance lead a one-page note: the capacity arithmetic, the ED commitment in writing, the referring-group attrition already underway, the specific dollar amount of overtime you are requesting, and the alternative you will use if you receive no answer by a stated date. Silence is not approval, but a documented request with a deadline protects you and gives finance a decision instead of a complaint.

Judgment point: the temptation is to absorb the gap by pushing the remaining 9 technologists harder. With two already on leave, that path produces a third absence or a resignation, and you cannot hire your way out of a three-week problem. Protect breaks and limit consecutive extended shifts even while you are short.

Communicate before they ask again. Call each referring practice's lead physician and office manager within 48 hours. Content: the specific part, the specific expected date, what you have already changed (extended hours, triage rules, waitlist), what they should do for urgent patients (call a named person directly), and a commitment to a written update every Friday until the second scanner is back. Do not promise a date you have not been given by the vendor - a broken promise costs more than a vague one. Offer to handle the scheduling and authorization legwork for any patient you redirect.

Recover the relationship with behavior, not apology. Referring practices leave over uncertainty and silence; a center that calls them first and answers the phone is hard to leave.

Measures to track daily during the outage and weekly for a quarter after:

• Appointment wait in days by study priority, and backlog count.
• Daily completed studies per scanner and scanner utilization percent.
• ED and inpatient turnaround; door-to-scan and scan-to-read separately, so you know which constraint you are actually fixing.
• No-show rate, and percent of slots recovered from the waitlist.
• Referring-volume trend by practice, and new referrals - the number that tells you whether the attrition stopped.
• Overtime and agency dollars against the pre-outage baseline.

Review point: if referring volume has not recovered four to six weeks after the second scanner returns, the problem is no longer capacity - it is trust, and it needs a service recovery plan with the practices, not a scheduling fix. Say that to your leader now so the expected timeline is set before the numbers come in.