Presentation on theme: "AHPwSI 6.11.03 Allied Health Professionals with Special Interest. AHPwSI Some experience from Diagnostic Radiography Liz Hunt - Radiology Directorate Manager."— Presentation transcript:
AHPwSI Allied Health Professionals with Special Interest. AHPwSI Some experience from Diagnostic Radiography Liz Hunt - Radiology Directorate Manager Addenbrookes NHS Trust
AHPwSI Two examples from Diagnostic Radiography Direct referral from GPs 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
AHPwSI 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.
AHPwSI 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 SpRs in training must gain competency Consultant Radiologists specialising, and performing more interventional work
AHPwSI 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
AHPwSI 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 )
AHPwSI 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
AHPwSI 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 GPs who get fast patient diagnosis and can refer on to appropriate specialist for treatment as necessary
AHPwSI Barriers to the process - Before introduction This is a teaching hospital we must enable SpRs 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
AHPwSI 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 SpRs Continual audit provides a standard for the service Can John cover my list?
AHPwSI 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
AHPwSI 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
AHPwSI Diagnostic radiographers trained to perform ultrasound Background in pattern recognition and cross sectional anatomy 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
AHPwSI 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.
AHPwSI 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)
AHPwSI PMB About 50% PMB occurs between ages of 50-59
Peak ages for particular gynae problems as predicted.
AHPwSI Stakeholder meetings GP cancer lead from PCTs Gynae Onc Consultant Consultant Radiologist Ultrasound Radiographer Clerical staff from all areas Manager from Gynae and Radiology
AHPwSI 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
AHPwSI Patient Pathway Patient to GP with PMB Examination by GP Patient referral proforma faxed to gynae onc and then to us Ultrasound within 2 weeks Normal diagnosis. Patient back to GP Abnormal diagnosis Patient referred to gynae onc Patient treated as required
AHPwSI Referral Proforma for GP
AHPwSI Scan Normal
AHPwSI Scan Abnormal
AHPwSI 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
AHPwSI 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
AHPwSI Acknowledgements To all my colleagues in Radiology, the gynae team, the GPs and our local PCTs Thank you for listening