UK recommendations for AAA screening organisation {2} were used to give an example of the human resources needed, and their workloads, responsibilities and training needs for systematic population-based AAA screening.

Clinical staff

Director/Clinical Lead (0.2 Whole Time Equivalent (WTE)* per 800,000 population)

A vascular surgeon, responsible to the National Programme Centre, will have responsibility for the overall running of the local programme and for clinical support for their Programme Coordinator, particularly in matters involving patient care. They will also be responsible for making clinical decisions related to screening patients up to the point where a referral has been made.

The primary purpose of this role is to act as the strategic lead for the local AAA screening programme. The Director will oversee the screening programme and take clinical responsibility. The role of the Director is to ensure the successful implementation of the programme and that a high quality service is maintained following implementation.

Lead ultrasound clinician (0.1 wte per 800,000 population)

A radiologist/consultant sonographer/vascular scientist will have special responsibility for quality assurance of staff and the screening process, and responsibility for the screening equipment, staff accreditation and monitoring of clinical performance (including review of scans from screening clinics). This task is often delegated to the clinical skills trainer but this is a local decision. Any quality assurance concerns should be brought to the attention of the director. They will advise on which ultrasound equipment should be purchased and when it needs to be updated or replaced.

Consultants in the vascular units

Vascular surgeons are not employed by the screening programme and are unlikely to participate in the screening programme as such.

In hospital vascular units, the consultant responsible for the care of the patient will be classed as the “responsible” doctor once the referral is received. They should:

• On referral from the local AAA screening programme, ensure that further confirmatory diagnostic image testing is performed and keep records of the findings of this testing
• Assess patients with a view to surgery
• Notify the coordinator of the local screening programme of the outcome of the initial and further outpatient visits and, if indicated, the treatment
• Submit data for audit purposes on an ongoing basis of all AAA surgery.

Screening staff

Clinical skills trainer (senior sonographer/vascular scientist – 0.1 wte per 800,000)

A senior sonographer/vascular scientist is responsible to the director/clinician lead. As the first-line supervisor of the screening technicians, the Clinical Skills Trainer is responsible for staff training and regular review of staff for quality assurance in addition to undertaking routine equipment quality assurance assessments and ensuring regular maintenance of the ultrasound equipment. CSTs also run occasional AAA screening clinics to maintain their skills. They should have extensive experience of training in the workplace. The work within these clinics will include:

• Ensuring that men attending clinics are booked in smoothly and efficiently and are aware of the benefits and risks of the AAA screening programme and give informed consent to the procedures
• Accurately recording aortic sonographic measurements
• Collecting other patient information
• Reporting scan results and their implications to patients both verbally and in writing
• Preparing copies of the results for GPs
• Transferring clinic data to the screening office
• Updating the screening management information technology  (IT) system

As with other clinical staff, more time may be required during initial set-up.

Screening technicians (3 wte per 800,000)

Screening technicians ensure that men attending clinics are booked in smoothly and efficiently and are aware of the benefits and risks of the AAA screening programme and give informed consent to the procedures. They will accurately record sonographic measurements of the aortic diameter, collect other patient information and report scan results and their implications to patients both verbally and in writing. They will also prepare copies of the results for GPs, transfer clinic data to the screening office and update the screening management IT system.

There will be a requirement for all those undertaking the scanning to have attended the nationally approved and accredited training course and fulfilled all the competency requirements of the training. It is recommended that all newly appointed screening technicians have an initial probationary period built into their contract to allow time for training and assessment of competency.

The CST is the first line supervisor of the screening technicians and in turn would be supported by the lead ultrasound clinician.

Nurse practitioner (0.1 wte per full capacity programme – 7,000 scans per year)

The nurse practitioner is involved in assessing and counselling men at specific points in the screening process and giving advice on changes in lifestyle as appropriate. Further referral on to other specialists should be made following discussion with the director of the local screening programme.

Management, administration and technical Staff

Coordinator (1 wte per 800,000 population)

The coordinator is responsible to the director/clinical lead, who delegates the task of the day-to-day running of the screening programme to the coordinator but remains the responsible clinician for patients entered into the screening programme. The primary purpose of the coordinator’s role is to direct the day-to-day operational management of the local programme. They oversee the work of the clerical officer and screening team.

Clerical officer (1 wte per 800,000 population)

The clerical officer is responsible for the administration and is the first point of contact between the screening population and the screening office. The work involves administering and processing patient invitations and appointments, recording information and updating data systems relating to results and patient outcomes and ordering supplies. The clerical officer plays a supporting role to the local AAA screening programme and ensures that members of the public are informed of the benefits of the programme.

Medical physicist (5 days per year for a full capacity programme – 7,000 scans per year)

The purpose of this role is to undertake acceptance of new ultrasound machines and to provide independent, regular quality assessments using sophisticated test objects. This specialist will undertake annual assessments on all the ultrasound machines and probes, assisted by the Senior Practitioner. They will prepare reports for the Director of the local programme.

IT lead

The IT lead supports the coordinator in the timely installation of IT equipment and software, in accordance with the IT checklist issued by the software supplier. The IT lead acts as a single site contact point for IT for the software supplier during implementation. The IT lead is responsible for ensuring the appropriate software for the programme is accessible and they will be available at a high level to troubleshoot when required. They will also facilitate the set-up and process for archiving screening data and back-up.

Governance

The provision of the AAA screening programme involves a number of organisations:

• Strategic Health Authorities
• Primary Care Trusts
• Primary care providers
• Local Screening Programme
• Diagnostic and Treatment Services {2}.
• Whole time equivalent is calculated by assessing the hours the employee is contracted to work and the standard hours for the position (generally 40 hours per week).