General Imaging Information Dr Heather Harris Clinical Director Imaging Department, CRH

Overview Imaging is key to every pathway Tight TATs for target requests 1 week from request to scan 1 week from scan to report Reality is often quicker Recent performance better than benchmark Some pathways tighter TATs

Specific Pathways Lung pathway Prostate Vague sx and jaundice Also Colorectal, upper GI, unknown primary, other urology, Breast, Gynae, H&N, dermatology etc

Imaging Email Advice Service Part of vague sx pathway Any enquiry, not just for vague sx Advice what test to do, what test to do next, interpretation of report, urgent report needed If really urgent, please phone Tel: 01246 516610 or 01246 512925

Practical Info CRHFT.imaging-secs@nhs.net Mon – Fri 0830 – 1700 Aim to respond within 3 working days Need patient name and either DOB, hospital number or NHS number Brief outline of the query Not for complaints please

Advantages You can email when convenient We can respond when convenient More considered response Allows time to look into the issue Doesn’t interrupt either of our working days Improved TAT for reporting

Outcomes so far Started 15th May 2018 67 enquiries Average TAT for response = 8 days 45 were 7 days or less 27 were 0 – 3 days 22 were more than 7 days, range 8 – 29 days BUT Delay in sending to consultant 0 – 3 days, 1 was 19 days Weekends have been included Aimed response is 3 working days from receipt Reality better but needs improvement Need to dig deeper into data

Big Change to U&Es for CT New guidance from RCR Contrast is no longer thought to be a main factor in AKI Now referred to as Post Contrast AKI instead of contrast induced AKI

Out patient/GP Requests Most OP/GP patients do not need U&Es Need to identify high risk patients

High Risk Out Patients Age >65 years Known renal disease including transplant kidney, solitary kidney, dialysis, renal cancer and previous kidney surgery History of hypertension requiring medical treatment History of diabetes Metformin or metformin containing drugs (due to risk of lactic acidosis in the presence of AKI, not PC-AKI)

High Risk Patients ICE has been changed Questionnaire for referrer Low risk vs high risk Low risk patients No U&Es!! High risk patients – questionnaire High risk factors are flagged up on our system Must have had U&Es within 1 month

High Risk Out Patients eGFR >45 ml/min/1.73m2 give iv contrast

High Risk Out Patients eGFR 30-45 ml/min/1.73m2 Give iv contrast CT staff give the patient a U&Es blood test form and advise them to have a blood test 48-72 hours after the scan. CT staff will record the pre-scan renal function, and will then follow-up the post scan blood result. If there is a significant deterioration in renal function (25%) CT staff will inform a radiologist and contact the GP with the result advice to recheck the renal function again at 7 days.

High Risk Out Patients eGFR <30 ml/min/1.73m2 Non contrast CT +/- liver ultrasound following advice from a radiologist

Benefits Saves time Saves money Reduced checking of U&Es Less patient trips to CRH or GP Less patients to follow up More time to do other tasks Saves money Reduced U&Es tests, blood forms, postage costs

Any Questions?