1. MRI in the NHS,Malta: The effectiveness of a radiographer led unit. Joseph Castillo B.Sc, M.Sc (HCM), M.Sc(MRI) St. Luke’s/Mater Dei Hospital

2. 2 Brief outline of SLH/MDH 500 bed hospital 1000+ employees 169,146 Imaging studies in 2006 MDH fully digital

3. 3 The first five years 1 Principal Radiographer and 15 Radiographers rotating daily 5 Consultant Radiologists vetting all requests. All IV contrast injections done by Senior Radiologists or Doctors.

4. 4 And the result was… 2 month delay to send appointments. Lack of ownership, accountability and motivation. Patient throughput delays – waiting to inject. Structural idle time Radiographers do thing as they know rather than the ‘new way’. All this leading to….

5. 5 A waiting list of 8 months in August,2006 Increased pressure from physicians who did not want their patients to wait that long.

6. 6 Proposed Change 2005 Upgrade to GE Twin Speed/Asset. Optimize Protocol to answer clinical question rather than routine scanning. Team with specialist radiographers – MRI and Sound Clinical Background. Team challenge started September 2006.

7. 7 Other measures Eliminate Saturdays (7:30 – 1:00pm) Introduce 15min overlap between shifts. Maximize patient transportation.

8. 8 Role Development All Radiographers specialized in all aspects of MR Imaging. All request forms vetted first by Radiographers Educate junior doctors on different MR protocols. IV injection done by Radiographers. Indirect reporting.

9. 9 One Great Team (OGT) People are working together Positive attitude pervades People have control over their work environment (sharing monkeys). Flexibility (very important in a small team) Cooperation is the norm. Attendance is high. Pride is abundant. The unit is highly respected and technically superior Think Giraffe!

10. 10 And now the results are… Appointments send within 1 week. Radiographers have ownership of all events happening in MRI. Satisfaction. No delays in exams requiring gadolinium injection Increased ‘overall physician experience’. Contributing towards patient’s outcome. And….

11. 11 In September 2007 waiting list has been reduced to 2 months (9weeks). Therefore increased ‘ overall patient satisfaction’ And Pressure from physicians over elective requests eliminated.

12. 12 Conclusion Our initial observation indicates: 1. increased efficiency 2. no reduction in patient safety 3. Some inevitable increase in on-call costs. 4. Maximized Radiographer’s Role in clinical outcomes.