1. Allied Health Professionals with Special Interest. AHPwSI
Clinical radiology Patients’ Liaison Group
Decided to survey our department
Some experience from Diagnostic Radiography
Liz Hunt - Radiology Directorate Manager Addenbrooke’s NHS Trust
AHPwSI
EAH/

2. Two examples from Diagnostic Radiography
Direct referral from GP’s for barium enemas undertaken by Radiographers.
Waiting list down from 3 months to 2 weeks
Direct GP referral for women with post menopausal bleeding into ultrasound.
outpatient appointments saved per year
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3. Barium Enema Barium is inserted into the bowel via a rectal tube
Air is added to produce double contrast
The patient is rotated during the test to ensure all the bowel is visualised
Detects cancer, diverticular disease, polyps etc.
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4. Diagnostic Radiographers performing Barium Enemas
The Problem
Long waiting list for barium enemas
2 week wait for cancer referral to diagnosis
Lists only available when Radiologist available
SpR’s in training must gain competency
Consultant Radiologists specialising, and performing more interventional work
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5. The solutions Increase the number of sessions
Vet the request forms more thoroughly
Decrease the specialist work
Train interested Radiographers in GI work and reward them for their skill
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6. The method Radiographer interested in GI work to undergo training
Leeds theory course
Practical work supervised by GI Consultant
100 barium enemas
Exam passed and Trust authorizes Radiographer to perform the examination
Reporting done jointly with the Consultant
( latest RCOR guidelines advise joint reporting by all staff )
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7. Radiographer assigned 2 lists per week
If waiting list rises schedule extra lists
Second Radiographer undergoes training
Back up for each other
No list cancellation
GP directly refer for barium enemas
Waiting list gone down from 3 months to 2 weeks
Quality control assessed by audit
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8. Results
High patient satisfaction with excellent patient care and reduced waiting list
High job satisfaction from Radiographer with specialist skills
Recognition as an advanced practitioner in line with the 4 tier structure
High satisfaction with GP’s who get fast patient diagnosis and can refer on to appropriate specialist for treatment as necessary
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9. Barriers to the process - Before introduction
“This is a teaching hospital we must enable SpR’s to get enough experience”
“How can a non medical member of staff be trained sufficiently to understand this”
“This is the beginning of the end”
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10. “Can John cover my list?”
After introduction
There is a positive impact in SpR training in that the Radiographers who have developed great expertise can contribute to training
On audit the diagnostic results for the Radiographer are better than those achieved by more junior SpR’s
Continual audit provides a standard for the service
“Can John cover my list?”
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11. Post menopausal bleeding - Background
It is a common gynaecological symptom
Women with PMB should be referred to a cancer unit for gynaecological assessment
“Improving outcomes in gynaecological cancers NHS Executive 1999”
Traditionally managed by D+C and hysteroscopy
Transvaginal ultrasound can be used as a screen for endometrial cancer in symptomatic postmenopausal women
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12. This group accounts for 45-50% of referrals
If the endometrial stripe is uniform and <5mm in thickness likelihood of malignancy is <1%
This group accounts for 45-50% of referrals
50% with +ve scans have intra-uterine pathology which can be assessed at hysteroscopy
Direct referral by the GP to ultrasound would allow patients with a normal scan to return to primary care without the need for a gynae clinic appointment
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13. Diagnostic radiographers trained to perform ultrasound
Background in pattern recognition and cross sectional anatomy
12-18 month training to qualify in ultrasound (Post graduate diploma)
Supervised at every stage
On qualification can perform ultrasound and give a report
Become an advanced practitioner on proving all competencies
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14. PMB
Ultrasonographers trained in the use of transvaginal scanning scan women with PMB and independently report on their diagnosis
Audit required to try and identify relevant patient group and perhaps extend the practice to patients with ? Pelvic mass.
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15. Ultrasound audit
Data collected for 3 months on all referrals for pelvic ultrasound (Nov.2002-Jan 2003)
Results divided by age into PMB, pelvic mass pain, abnormal bleeding and general (330)
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16. PMB
About 50% PMB occurs between ages of
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17. AHPwSI

18. Peak ages for particular gynae problems as predicted.
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19. Stakeholder meetings GP cancer lead from PCT’s Gynae Onc Consultant
Consultant Radiologist
Ultrasound Radiographer
Clerical staff from all areas
Manager from Gynae and Radiology
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20. Agenda To discuss the concept and get agreement
To discuss the paperwork required
To identify the patient pathway
To ensure a fallback for patients who did not conform to the pathway
To clear the hysteroscopy waiting list
To agree the process
To keep the referral threshold constant
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21. Patient Pathway Examination by GP Patient to GP with PMB
Patient referral
proforma
faxed to gynae onc and
then to us
Patient to
GP with PMB
Normal diagnosis .
Patient back to GP
Patient treated as
required
Ultrasound within
2 weeks
Abnormal diagnosis
Patient referred to
gynae onc
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22. Referral Proforma for GP
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23. Scan Normal
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24. Scan Abnormal
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25. Conclusion
Primary and secondary care working in partnership for better patient care
GP continues to make decisions about referral based on their consultation
Diagnosis and consultation simultaneously saving patient journeys to the hospital
Fast referral for worried women
Improved use of out patient appointments
appointments saved
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26. Radiographers work independently in ultrasound to deliver the diagnosis.
Consultant Radiologist time available for other more complex work e.g. neck lump biopsy.
Next steps
To audit numbers
To develop a similar pathway for pelvic masses
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27. Thank you for listening
Acknowledgements
To all my colleagues in Radiology, the gynae team, the GP’s and our local PCT’s
Thank you for listening
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