CT Colon Service & Radiology Pathways Louisa Edwards CT Colon Advanced Radiography Practitioner ABMU 6 th February 2019 Louisa.Edwards@wales.nhs.uk CT, Radiology Dept, POWH, ABMU Health Board
Context and Problem CTC procedure o very powerful 2day laxative preparation with a tagging agent o low residue (restricted) diet CTC is an invasive procedure for the patient o involves colonic insufflation using CO2 SIGGAR trials published in The Lancet in 2013 o CTC more sensitive test than barium enema o Similarly sensitive, less invasive alternative to colonoscopy
1 2 3 Demand for CTC had risen Lack of resources to accommodate increase Bottleneck issues with national shortage of Consultant Radiologists Issues Identified
Strategy for Change Implement New CTC Advanced Radiography Practitioner Funding secured from Cancer Innovations Fund/1000 Lives Train & implement an Advanced Practice CTC Reporting Radiographer Allowing the radiographer to perform & report CTC scans to detect bowel cancer & colorectal diseases Providing a more prudent system by reducing waiting times for scans & results Earlier intervention & treatment
Strategy for Change Implement New CTC Advanced Radiography Practitioner Translation of formal knowledge (PG Cert) into clinical practice Patient centred approach to improve quality Patient satisfaction survey o Showed a lack of information given prior to CTC procedures o Information confusing and difficult to understand Improvement of patient procedure information and appointment letter
Measurement of Improvement 1200 1000 800 600 400 Total CTC Procedures 212 0 806 672 10 917 100 80 60 40 Mean calendar days waiting time for CTC procedure 47 55 78 92 24 26 23 24 200 20 0 0 2015 2016 2017 2015 2016 2017 Jan - Jun 2018 Total requested Outsourced POWH NPTH
Measurement of Improvement 100 80 60 40 20 0 % OF USC PATIENTS SCANNED WITHIN 2 WEEKS 37% 73% 2016 2017 N.B. There will always be a small % of patients who will not be scanned within this time frame as it is not in their best interests REPORTING AUDIT For CTC Advanced Practitioner reporting purposes: Polyps >5mm (0.5cms) Compared to Radiologist report Royal College of Radiologists target: Sensitivity >75% Specificity >95% Sensitivity 100% (RCR >75%) Specificity 96.3% (RCR >95%)
Effects of Changes Positive Impact Reduced waiting times for scanning procedures Increased capacity & throughput by providing dedicated lists Delegated Authorisation Guideline (DAG) Straight to chest staging when cancer identified CTC ARP vetting of referral forms Saved over 30 hours of Radiologist time CTC ARP independent reporting Saved over 35 hours of Radiologist time
Effects of Changes Positive Impact Involvement in MDT Liaison with CNS, Surgical team etc. Point of contact Radiographers, patients, CNS, BSW Increased knowledge and training for CT radiographers o Improved role development and confidence Undergraduate University lectures to pass on core CTC skills o Cardiff University
Lessons Learned Full support required Time constraints Radiologists available to mentor Staff shortages Reduction in qualified Radiographers to train Colleague perception of training requirements Time required Understanding of input & work involved Resistance to Radiographer reporting Personal challenges
NHS Wales Awards 2018 Finalists Flexible and Sustainable Workforce Opportunity to provide Radiographers in Wales with Advanced Practice Training
1 2 3 Improved service delivery, increased capacity & reduced waiting times Provided transferable model of work to other modalities & depts. Working with HEIW/Agored to provide National CTC Radiography training Summary
Radiology Complex Imaging Pathways GP CXR to CT Red Star Fax GP & email Chest Physicians Complete CT Staging request/attach report Rectal Ca MRI & CT Referrals for CT & MRI marked as joint scan Coordination between MRI & CT appointing MRI allocated first Neck Ca U/S CT & MRI Referrals for U/S, CT & MRI marked as joint scan Vetted & marked as 3 modalities Endometrial Ca U/S Hysteroscopy & MRI One-stop shop TVS/US/Hysteroscopy If confirmed referred for MRI Checked by CT Radiographer CT slotted in as extra on same day Form copied & given to each dept. Radiographer vetting of USC form & appointed Appointed as USC All discussed at MDT within 1 week of scans Appointments booked within 2 weeks
Radiography Advanced Practice Advantages to diagnostic radiography advanced practice Valuable asset Time can be utilised for o Vetting o Reporting o Navigation o Discussing results with patients Radiographers could be working more with cancer agencies Macmillan, Tenovus Providing patient centred approaches to diagnostic pathways and follow up imaging
Thank you for listening. Any questions?