Transcript MRI in the NHS,Malta: The effectiveness of a radiographer

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
Brief outline of SLH/MDH
• 500 bed hospital
• 1000+ employees
• 169,146 Imaging
studies in 2006
• MDH fully digital
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2000 2002 2004 2006
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MRIs
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.
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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….
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• A waiting list of 8 months in August,2006
• Increased pressure from physicians who
did not want their patients to wait that
long.
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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.
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Other measures
• Eliminate Saturdays (7:30 – 1:00pm)
• Introduce 15min overlap between shifts.
• Maximize patient transportation.
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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.
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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!
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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….
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• 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.
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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.
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