MEDICAL IMAGING AND PACS
Performance improvement Assessing excellence: how good is your trust’s imaging department?
M
edical imaging accounts for over £1bn of NHS expenditure (2008/9 fi gures) 1
covering 2,062 consultant clinical radiologists2 across over 100
imaging departments.3
Imaging plays a critical diagnostic role in many patient pathways, and, through interventional radiology, an increasingly important role in patient treatments.
The Department of Health website includes many documents on medical imaging, focused in the main on good practice in specifi c elements of imaging.4 However, there is little national benchmarking for imaging department performance,5
and there is
little guidance on what to measure when assessing the overall performance of an imaging department.
referring physician in as short a time and least costly manner as possible’.
• For the remaining 3% of interventional activity, a more surgically-oriented purpose should be adopted: ‘diagnosing and treating patients promptly, through minimally invasive procedures resulting in excellent clinical outcomes and minimum patient discomfort, in the least costly manner possible’. Both defi nitions above rely on a need for high quality (minimum disruption, high satisfaction and
• Inpatient: ideally under 24 hours, defi nitely under 48 hours. • Outpatient: national targets require less than 6 weeks, as part of the 18 week pathway. Much shorter waiting times (e.g., less than 7 days) are required for cancer patients, and are both possible and desirable for all outpatients if the enablers below are implemented.
Medical imaging costs the NHS over £1bn per annum but there is little guidance on what excellence looks like for the service. Russell Cake, director and co-founder of 2020 Delivery and the former leader on NHS reform in the Prime Minister’s Delivery Unit, and Elizabeth Thurgar and Antonio Weiss, both senior consultants at the organisation, here outline eight metrics to help assess the quality of imaging departments.
In this article we outline some ideas around how and what to measure to assess the performance of a medical imaging department.
What measures can we use to assess excellence in a medical imaging department? In order to measure excellence we must fi rst understand the core purpose of a medical imaging department:
• For non-interventional imaging and radiodiagnostic examinations (97% of NHS imaging activity)6
, the primary purpose is
around ‘getting an accurate, clinically relevant report based on high-quality images to the
52 | national health executive Jul/Aug 12
accuracy) at the lowest possible cost. Below, we outline some recommended measures and their rationale, and discuss for each measure the proposed target, the required enablers for good performance and how to evaluate progress against the measure.
1. Waiting times
Diagnostic tests are a vital step on the patient pathway. Any delays or blockages have a detrimental impact on patient care, and also add cost for referring specialties.
The target for waiting times should be:
Enablers for good performance: Single- point call centre for patient bookings; vigilant management of capacity and demand of service; modality pathway redesign; sweating assets (e.g., CT and MRI scanners) by extension of working hours; dedicated radiology porters.
How to measure: There are several possible ways to estimate waiting times, for
example: (i) Based on historic actual waiting times for historic patient cohorts; (ii) Based on ‘clearance times’ for patients currently waiting; (iii) Prospective waiting times based on ‘next available slots’ for different patient types. Whichever method is chosen, the key is to measure consistently, and to keep waiting times below agreed thresholds.
2. Reporting turnaround times
Low reporting turnaround times minimise the delay before a diagnosis can be made and demonstrate high level of customer service (to referring physician).
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