News & Events

Position statement regarding CQC review of backlogs in radiology

06 December 2017

inourworldbmp

There have been recent media reports concerning backlogs of radiology examinations within the NHS due to a deficit of radiologists. This follows a CQC order for all NHS bodies to provide details on their backlogs, turnaround times, staffing, and arrangements for routine reporting of images.

RRO confirms that its organisational average turnaround time for routine cases is 26 hours with 98% of all routine cases reported under 72 hours over the last 3 months. Over 99% of acute cases are reported within 60 mins, with an average turnaround time of 23 mins.

These strong performance figures, follow a significant recruitment exercise over the last twelve months, which has seen RRO’s team of GMC specialist, FRCR radiologists with NHS consultant experience grow by 55% to a team of over 200.

RRO confirms that it has strong radiologist capacity and a significant stream of new radiologists joining the team each month.  RRO is well positioned to immediately assist new clients to manage ever increasing demand.

With established national teleradiology framework agreements, NHS trusts can quickly and compliantly contract with teleradiology suppliers without the requirement of going through lengthy tendering processes.

RRO’s Clinical Director, Dr Robin Evans earlier this year issued guidance on how to best work with teleradiology providers, this guidance has been updated below:

Routine Reporting

  • Invest in your relationships. Work with your teleradiology partner like they are an extension of your own department.  Talk to them weekly.
  • Don’t wait for backlogs to accrue, deal with the clinical risk immediately. It is easier for a teleradiology company to report frequently for their clients, than to be presented with a batch of thousands of examinations.
  • Communicate any foreseeable increase in demand in advance. Your partner may not have the immediate capacity if they are not forewarned.
  • Demand technical automation of workflows. This will ensure that when the time comes that you can quickly bulk assign cases for sending to your teleradiology partner.  This may include, bi-directional HL7 messaging, allowing bulk case assigning and automated report delivery.
  • The process for notifying critical and unexpected findings should be robust. These processes have recently been well summarised in the recent RCR publication “Standards for the communication of radiological reports and failsafe alert notification” which do also refer to teleradiology requirements.
  • It is important to remember that selecting cases for notification depends on the professional opinion of the reporting radiologist who may not be familiar with local practice or procedures. The teleradiologist cannot be expected to remember variable practice across sites. An effective system needs to be in place for processing unexpected finding notifications from the teleradiology providers. This requires a robust agreed local policy and allocation of administration time to implement this.

Urgent After-hours reporting

Partnering with teleradiology for after-hours reporting can free up local teams to focus on daytime reporting and attend MDT’s and can provide a richer training environment for registrars.  It can also assist with recruitment and retention of radiologists.

  • The best starting point is an on-site planning meeting which must involve local managers, radiologists, senior radiographers and administrative staff. It is important to agree the referral process in detail and listen to the teleradiology provider requirements on key factors such as IT integration and scan protocols.
  • Moving to a new service can be an excellent opportunity to reinforce local clinical scan indications and scan exclusions as a teleradiology provider will generally be happy to be involved in demand management.
  • Experience has shown the value of referrer/teleradiologist clinical discussion for emergency body scans. This ensures adequate clinical information to optimise report and also ensures correct scanning in contrast protocols. The value of such discussions for emergency head CT indications is more questionable given well-established national protocols such as NICE head injury guidance. Very few emergency head CT scan requests are rejected following discussion and a telephone conversation serves more to interrupt and delay reporting rather than provide clinical benefit. Establishing local direct-to-scan arrangements for emergency head CT prior to radiology outsourcing should always be considered. It is vital that CT radiographers are on board with this and the indications and process are agreed with them.

To discuss any reporting requirements please contact the RRO team on 0300 400 1111 or enquiries@rrol.co.uk