MEDICAL IMAGING AND PACS
Best practice guidance from the NHS Institute for Improvement indicates the following targets for imaging report turnaround times: • Urgent cases – Immediate (within 30 minutes)
• Inpatients and A&E – Same working day • All other cases – By next working day
This is a speed of turnaround time that remains an aspiration for many trusts, in particular for outpatient cases, where turnaround times of up to a week are common.
Enablers for good performance in this area include: vigilant management of capacity and demand of service; digital direct reporting fully integrated into picture archiving and communication systems (PACs), together with voice recognition; pool-based reporting systems rather than systems that assign scans to individual radiologists for reporting; strong departmental activity resilience; central radiological reporting area; standard reporting format for common examinations.
How to measure: Historic turnaround times are easy to measure from RIS data.
3. Reporting quality
High reporting quality ensures that reports are clinically relevant and easy for referring clinicians to interpret. Referring clinicians say that they see variation in report quality: some
Enablers for good performance: Fostering a culture which encourages immediate reporting of clinical incidents, and active management of incident reports (including all incidents responded to within 14 days).
reports are better than others in the clarity with which they describe the diagnosis and any relevant context (e.g. from previous scans for the same patients), and in terms of being brief while still including directly relevant information.
How to measure: Historically, it has been difficult to measure reporting quality in a cost-effective way, however that is changing. The latest RIS-PACS systems make it possible for a random sample of reports (e.g. 1%) to be double-reported, without the clinicians involved knowing that they are double- reporting. Referring clinicians can then be invited to give each of the two reports a score (e.g. on range 1 – 5). This provides a simple, low cost mechanism for assessing reporting quality.
4. Clinical incidents
To have consistently excellent performance, any clinical department needs to understand what incidents are occurring, what the root causes of the incidents are, and to have a culture of continuous improvement to address root causes.
How to measure: Record all clinical incidents, where they occurred, and the reasons why. Record closure of clinical incidents when agreed actions are completed.
5. Patient experience
In the best cases, imaging can be a quick and seamless part of the patient’s pathway. But too often, patient experience is poor: this can start from patients finding it difficult to locate the imaging department, to patients misunderstanding what to expect when they arrive (this is especially the case for Interventional
Radiology procedures), to
patients experiencing long waiting times or poor signposting within the department.
Enablers for good performance: Well-designed and patient friendly departmental layout; low waiting times and report turnaround times; excellent accessibility for patients (e.g., good patient transport and car parking facilities); easy booking processes, with patients being given choice of slot time where appropriate; clear information on what to expect, especially in the case of Interventional Radiology, but also where contrast medium is used or where anaesthetics are used.
How to measure: Conduct regular patient experience surveys.
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