1. No category

How to manage demand, costs
and quality in Imaging
Prof Erika Denton, National Clinical Director for Diagnostics
The Health Roundtable
Sydney
February 28th 2014
• The NHS and imaging
•
•
•
•
•
•
•
Imaging data
Evidence, guidelines & imaging
Demand vs capacity
Service improvement work
Geographical variation
7 day & 24/7 working
The money!
The aim for all healthcare…..
To deliver appropriate, good quality, cost effective care
co-ordinated across primary and secondary care
NHS Outcomes Framework
Commissioning to support delivery of 5 domains:
• Domain 1 To prevent people from dying prematurely
• Domain 2 To enhance the quality of life for people with long term conditions
• Domain 3 To help people recover from episodes of ill health or following injury
• Domain 4 To ensure that people have a positive experience of care
• Domain 5 To treat and care for people in a safe environment and protect them
from avoidable harm
The New Language!
CCG
Clinical Commissioning Group
211
CSU
Commissioning Support
Unit
23
Federation of G.P practices
Expected seamless transfer of
services/responsibilities from PCTs
Train CCGs
NCB/
National Health Service
NHS CB Commissioning Board
Act as host for CCGs and CSUs
LMC
Local Medical Committee
CCG need to engage with existing LMCs
LAT
Local Area Team
•
•
27
Hold the budget for specialist services
Responsible for direct commissioning of GP,
dental, pharmacy and (some) optical services
LETB
Local Education & Training
Board
Workforce Deaneries
HEE
Health Education England
Special Health Authority responsible for
authorisation of LETBs
GPPO
GP Provider Organisation
NHS or Private Providers
Department of
Health
Monitor
Clinical
Senates
Care Quality
Commission
NHSE
Health Watch
Clinical
Commissioning
Groups
Local
Authorities
Providers
Primary Care Commissioning
It’s not new!
1991 G.P Fundholding (Thatcher)
2005 Practice Based Commissioning (Blair)
but both voluntary
Sounds simple for a CCG….?
Trauma
100s of single
provider
contracts or
individual patient
placements
<£100k
Deprivation
Dementia
Cataracts
Weight management
A&E
Cancer
10 - 30 smaller
inpatient and
community contracts
c. £1million
1-3 large acute
contracts, value
>£50million
General surgery
Depression
Maternity
Neurology
Disadvantaged
groups
Rehab
Respiratory
Comorbidities
Long Term conditions
Specialised Commissioning
• Specialised services, a few specialist centres, popn >1m
• For rare & v rare conditions previously commissioned at
national & regional level
• Directly commissioned by NHS England
• The Specialised Services National Definitions Set
(SSNDS) covers relevant conditions & treatments
• SSNDS designed to form solid basis for commissioning
specialised services by NHSE
• Standardised structure for all CRGs
Networks: Strategic Clinical
Bring together 1°, 2°, 3°, social care, 3rd sector & patients
as pathways complex and cross boundaries
Hosted regionally as large scale change required
• Cancer
• Maternity & children’s services
• Cardiovascular disease (including cardiac, stroke,
diabetes and renal disease)
• Mental health, dementia and neurological conditions
Networks: Operational Delivery
To work closely with strategic clinical networks, all providers,
commissioners & patients
• Neonatal ITU
• Adult critical care
• Burns
• Trauma
• Paediatric congenital heart Sx
• Paediatric neuroscience
• Adult congenital heart Sx
The NHS Funding Gap…
Projected Rate Of Population Growth
By Age Last Birthday
The vast majority of
increase in
population over the
next 6 years is
predicted to be in
the 60+ age bracket.
16%
14%
Under 60 (% increase from 2004)
Over 60 (% increase from 2004)
12%
10%
Projected Population
Increase from 2004 % 8%
6%
4%
2%
0%
2004
2005
2006
2007
2008
2009
2010
2011
2012
Under 60 (% increase from 2004)
0.0%
0.5%
0.8%
0.8%
0.7%
0.9%
1.0%
1.3%
1.5%
Over 60 (% increase from 2004)
0.0%
1.4%
2.8%
5.6%
7.9%
9.8%
11.5%
13.1%
14.6%
Year
(Source: Government’s actuarial
department).
Causes Of Death, over 60s
Respiratory
Diseases
80% of death of
the over 60s
attributed to 3
underlying
causes
GI Disease
Neoplasms
Mental/Behavioural
CNS Disease
Abnormal Findngs
All Others
Circulatory Diseases
10% of NHS spend, £8 billion
1 billion tests pa
inc colonoscopy
Endoscopy
Eg Audiology, Resp, Cardiac
Physiology
Cyto & moloecular genetics
Genetics
Blood, Cellular, Infection
Pathology
eg x-Ray, CT, MRI, ultrasound
Imaging
The five pillars of diagnostics
The five pillars of diagnostics
Why do we have a Challenge?
Because the equation…
Demographics + Patient / Public
Expectations + Quality
Money
Rising to the Challenge?
Demographics + Patient / Public
Expectations + Quality
Money
Solution = transformational change to the
current way of delivering health care
‘Old’ vs ‘New’ change methodology
Transactional change:
Doing things better
Transformational change:
Doing better things
‘You can’t solve a problem by using
the same thinking that created it’
Albert Einstein
National Data
• Equipment
•
•
•
•
•
DMO1
Intervention Rates
DID
NHS IQ work
The Atlas of Variation
1 – Data refer to exams in hospital only.
1 – Data refer to exams in hospital only.
2 – Data refer to exams outside hospital only.
2 – Data refer to exams outside hospital only.
6+ week waits April 06 – July 13
6+ week waits April 06 – July 13
6+ week waits April 06 – July 13
6+ week waits April 06 – July 13
6+ week waits April 06 – July 13
6+ week waits April 06 – July 13
Waiting List & Activity: MRI
Waiting List & Activity: CT
Waiting List & Activity: US
Waiting List & Activity: Ba enema
Waiting List & Activity: Dexa
Waiting List & Activity: all imaging
The Diagnostic Imaging Dataset: DID
• Monthly
• Direct from RIS
• Every imaging event: requester, demographics,
code of test etc
• Report turnaround & waiting times
• Link to outcomes via HES & Cancer registries
• Extending to include all diagnostics
Aim: to establish “optimum” intervention rates
Report Turnaround
• Agreed with stakeholders
• Not evidence based
• Aspirational
• Within 1 hour for critical patients
• Within 12 hours for urgent patients
• Within 24 hours for non-urgent patients
DID: Chest x-ray usage by CCG
Chart 1 – Rate per 1000 GP Registered Population
GP Direct Access activity
45.00
40.00
35.00
30.00
25.00
20.00
15.00
10.00
5.00
0.00
0
50
Median
Mean
100
150
NHS Airedale, Wharfdale And Craven CCG
200
Low er Quartile
250
Upper Quartile
DID: Ultrasound usage by CCG
GP Direct Access activity
25.00
20.00
15.00
10.00
5.00
0.00
0
50
Median Mean of CCGs
100
150
200
NHS Barking And Dagenham CCG Low er Quartile Upper Quartile
250
Life in Radiology?
Just do more!!
1 – Data include equipment in hospital
only.
1 – Data include equipment in hospital
only.
National Audit Office Report 2011
Managing high value capital
equipment in the NHS in England
• MR, CT, RT linacs
• Poor VFM in purchase &
maintenance
• Variable utilisation
• Poor cost & performance data
NHS Service Improvement
Interventional Radiology:
the evidence for change
the
evidence
for
change
• NCEPOD on Trauma, Renal, IR & Neuro IR, AAA
• NICE: UAE, NAI etc
• Northwick Park Maternity Services HCC report
• Birmingham Children’s Services HCC report
• National Imaging Board’s reports:
‘Interventional Radiology: Improving Quality and
Outcome for Patients’
‘Interventional Radiology: Guidance for Service
Delivery’
DH involvement with
Interventional Radiology
• Interventional Radiology (IR):
‘Improving Quality and Outcomes
for Patients’ (DH, National Imaging
Board 2009)
• Interventional Radiology: Guidance
for Service Delivery (DH 2010)
• Delivering the Service:
Interventional Radiology for Major
Trauma Networks (DH 2010)
• Towards best practice in IR – (NHS
Improvement 2012)
College Guidelines: RCR (2009):Standards
for providing a 24-hour radiology service
Acute intervention including damage control surgery, . . . .
. . . . . interventional radiology, haemorrhage control,
and blood transfusion.
Interventional suites should be co-located with
operating rooms &/or resuscitation areas.
Interventional radiology (IR) taking place within an MTC
should be available 24 hours a day.
Patients requiring acute intervention for haemorrhage
control should be in a definitive management area
(operating room or IR suite) within 60 mins of arrival.
IR Programme 2011-12:
Trauma & IR
Aim: 24/7 Interventional Radiology services in all
Major Trauma centres
• National Survey
• Visits to 24 Major Trauma Centres
• Publication of Learning Document
• 2 National Workshops to launch the document and
share good practice
IR work in 2013: access to IR
IR work in 2013
Aim: Provide access to IR services for all, 24/7
Focus on core procedures- embolisation for
haemorrhage (general and PPH), endovascular
intervention, nephrostomy
• Promoting Networks
• East Midlands and South West (Interviews and visits)
• Other possible networks (telephone interviews)
• Workshops East Midlands and Southwest
• 3rd IR Survey 2013
NHS Improvement Survey
2011, MTCs
Red: No core service
provision and no network
pathways - includes
adhoc rotas.
Amber: Some core
services available on a
formal rota, limited formal
network provision
Green: Core service
provision or partial
service provision with a
formal rota and formal
network pathways to an
agreed recipient trust.
White : No data received
2011 Survey
2012
Survey
2011 Survey
2012
Survey
Total IR RAG status
(as at 16/05/2012)
100%
90%
20.6%
28.4%
80%
70%
28.2%
60%
26.9%
50%
40%
30%
51.1%
44.8%
20%
10%
0%
Survey 1
Survey 2
Staffing (Actuals)
350
300
250
200
150
100
50
0
North East
North West
Yorkshire
and
Humberside
WTE Radiologists
East
Midlands
West
Midlands
IR Radiologists
East of
England
London
Radiographers
South East
Coast
South
Central
IR Nurses
South West
Yo
rk
or
th
Ea
st
W
es
t
or
th
C
So
ut
h
So
ut
h
W
es
t
en
tra
l
Ea
st
Co
as
t
Lo
nd
on
Hu
m
be
rs
id
e
Ea
st
M
id
la
nd
s
W
es
tM
id
la
nd
s
Ea
st
of
En
gl
an
d
an
d
So
ut
h
sh
ire
N
N
# Interventions
Nephrostomy - Interventions per Radiologist
35.00
30.00
25.00
20.00
15.00
10.00
5.00
0.00
Yo
d
W
es
t
en
tra
l
st
do
n
d
ds
Co
a
C
ut
h
ut
h
So
So
e
t
ds
ng
la
n
la
n
an
Lo
n
fE
M
id
id
l
Ea
st
st
o
ut
h
Ea
W
es
t
st
M
rs
id
W
es
Ea
st
be
or
th
or
th
um
N
H
Ea
an
So
rk
sh
ir e
N
# Interventions
Uterine Fibroid Emolization - Interventions per
Radiologist
10.00
9.00
8.00
7.00
6.00
5.00
4.00
3.00
2.00
1.00
0.00
Two key issues remain
1. Lack of network
approaches
2. Lack of IR
Radiologists
MILTON KEYNES HOSPITAL NHS
FOUNDATION TRUST
BEDFORD HOSPITAL NHS
TRUST
BUCKINGHAMSHIRE HEALTHCARE
NHS TRUST
LUTON AND DUNSTABLE
HOSPITAL NHS FOUNDATION
TRUST
NUFFIELD ORTHOPAEDIC CENTRE NHS
TRUST
OXFORD RADCLIFFE HOSPITALS NHS
TRUST
ROYAL BERKSHIRE NHS FOUNDATION
TRUST
WEST HERTFORDSHIRE HOSPITALS
NHS TRUST
HEATHERWOOD AND WEXHAM PARK
HOSPITALS NHS FOUNDATION TRUST
IR Consultant
IR Radiographers
IR Nurses
Nuffield
4
4
7
H Wood & W Pk
5
5
2
W Hearts
2
6
4
R Berks
4
4
9
Bucks health
2
8
3
Bedford
1
5
4
Luton
2
7
2
Oxford
6
7
10
M Keynes
2
2
2
Total
28
48
44
South West
UNIVERSITY HOSPITALS COVENTRY AND
WARWICKSHIRE NHS TRUST
SOUTH WARWICKSHIRE
WORCESTERSHIRE ACUTE HOSPITALS
NHS TRUST
GLOUCESTERSHIRE
HOSPITALS NHS
FOUNDATION TRUST
ROYAL UNITED HOSPITAL BATH NHS
TRUST
GREAT WESTERN HOSPITALS NHS
FOUNDATION TRUST
WYE VALLEY NHS TRUST
UNIVERSITY HOSPITALS BRISTOL NHS
FOUNDATION TRUST
NORTH BRISTOL NHS TRUST
WESTON AREA HEALTH NHST
IR Consultants/Consultant
Radiologists
IR Radiographers
IR Nurses
RUH Bath
3/16
5
4
UH Bristol
7/29
4
3
Gloucester
3/12
4
6
S Warwickshire
4/9
0
0
Great Western Hospitals
3/11
5
4
Worcester
3/14
8
3
Wye Valley
1/8
3
1
Coventry and Warwick
4/25
3
8
North Bristol
6/24
6
12
Weston Area Health
1/6
1
0
35/154
39
41
Total
• Interventional
Radiology
• On site
Yes
No
84
48
64%
36%
The NHS Atlas of Variation
Looking at rate of healthcare interventions undertaken per
population
eg. For sleep studies 2010/11
60 fold variation between the highest PCT and lowest PCT
still a 27-fold variation, when you don’t consider the top 5
and bottom 5 PCTs
Similar pattern across diagnostic services
Rate of magnetic resonance imaging (MRI)
activity per weighted population by PCT, 4
fold variation
2010/11
Rate of dual-energy X-ray (DEXA) scan
activity per weighted population by PCT, 13
fold variation
2010/11
Rate of PET/CT activity per population,
by PCT, 25 fold variation
2010/11
National Evidence Based Guidelines
iRefer – from The Royal College of Radiologists
• seventh edition, evidence based and referenced adult and
paediatric imaging referral guidelines
• available via N3 free to all NHS organisations
• to help referrers determine most appropriate imaging
http://nww.irefer.nhs.uk/about/#Abt2
Open 24 hours?
Open 24 hours?
Norfolk & Norwich University Hospital
NHS Foundation Trust
Why should we change?
• ↓ cost & make best
use of resources
• ↑ demand vs capacity
• ↓ length of pathways
• ↓ waiting
• Patients want us to
• Commissioning
Other papers…..
Cavallazzi R, Marik PE, Hirani A, Pachinburavan M, Vasu TS, Leiby BE. Association between time of
admission to the ICU and mortality: a systematic review and metaanalysis. Chest. 2010;138(1):68–75.
Marco J, Barba R, Plaza S, Losa JE, Canora J, Zapatero A. Analysis of the mortality of patients admitted to
internal medicine wards over the weekend. Am J Med Qual. 2010;25(4):312–318.
Kuijsten HA, Brinkman S, Meynaar IA, et al. Hospital mortality is associated with ICU admission time.
Intensive Care Med. 2010 Jun 15 (E pub ahead of print) PubMed PMID: 20549184.
Dorn SD, Shah ND, Berg BP, Naessens JM. Effect of weekend hospital admission on gastrointestinal
hemorrhage outcomes. Dig Dis Sci. 2010; 55(6):1658–1666.
James MT, Wald R, Bell CM, et al. Weekend hospital admission, acute kidney injury, and mortality. J Am
Soc Nephrol. 2010;21(5):845–851.
Schilling PL, Campbell DA Jr., Englesbe MJ, Davis MM. A comparison of in-hospital mortality risk conferred
by high hospital occupancy, differences in nurse staffing levels, weekend admission, and seasonal
influenza. Med Care. 2010;48(3):224–232.
Horwich TB, Hernandez AF, Liang L, et al.Get With Guidelines Steering Committee and Hospitals.
Weekend hospital admission and discharge for heart failure: association with quality of care and clinical
outcomes. Am Heart J. 2009;158(3):451–458.
Shaheen AA, Kaplan GG, Myers RP. Weekend versus weekday admission and mortality from
gastrointestinal hemorrhage caused by peptic ulcer disease. Clin Gastroenterol Hepatol. 2009;7(3):303–
310.
Aujesky D, Jimenez D, Mor MK, Geng M, Fine MJ, Ibrahim SA. Weekend versus weekday admission and
mortality after acute pulmonary embolism. Circulation. 2009;119(7):962–968.
Why the variation across the week?
Patients at weekends
• Fewer discharges to alternative place of rehab or death
• People wait longer before seeking help, admission thresholds raised
Staff at weekends
• Fewer
• Less experienced
• More exhausted
Available services
• Diagnostics
• Specialist interventions
• Discharge support
Whole system change essential
Across whole service
Primary and
secondary care
Social services
Transport, pts & staff
Childcare, staff & pts
NHSE 24/7 Forum
• Reported Autumn 2013
• Multidisciplinary, chair Sir Bruce Keogh
Initial focus:
• Prompt access to consultant review & MDT assessment
• Availability of diagnostics to support decision-making
• Ensuring timely treatment and interventions
• Enabling safe and appropriate discharges
Clinical Standards for 7day care
Diagnostics, standard 5
Hospital inpatients must have scheduled 7-day
access to diagnostic services such as x-ray, US,
CT, MRI, echocardiography, endoscopy,
bronchoscopy and pathology. Consultant-directed
diagnostic tests and completed reporting will be
available seven days a week:
• Within 1 hour for critical patients
• Within 12 hours for urgent patients
• Within 24 hours for non-urgent patients
7-Day Radiology…..
• Critical patients: for whom the test will alter mgt. at the time
• Urgent patients: for whom the test will alter mgt. but not
necessarily that day
• Diagnostic results should be seen & acted on promptly by
the MDT, led by a competent decision maker
• Where a service is not available on-site (e.g. interventional
radiology/endoscopy or MRI), clear patient pathways must
be in place between providers
• 7-day consultant presence in radiology is envisaged.
Intervention / key services
Standard 6:
• Hospital inpatients must have timely 24 hour access, 7
days a week, to consultant-directed interventions that meet
the relevant specialty guidelines, either on-site or through
formally agreed networked arrangements with clear
protocols, including:
• Critical care
• Interventional radiology
• Interventional endoscopy
• Emergency general surgery
Service delivery model
In Patient
24/7
A&E
Stroke Strategy
Primary Care Increased Access
Extended Day +/- 7/7
Diagnostics
Patient Choice
Secondary Care delivery – Out Patient
Tertiary Care
Specialist Care
NHS Funding for Imaging
•
•
•
•
•
•
Tariffs for directly accessed and out patient imaging
Bundled into in-patient tariffs
Block contracts for some plain film and US
Some best practice tariffs
Choice and ‘Any Qualified Provider’
CCG vs specialised commissioning
MR Tariff
HRG
code
HRG name
2012-13
Cost of
tariff
reportin
(including
g
the cost of
2012-13
reporting)
(£)
(£)
Magnetic Resonance Imaging Scan
RA01Z Magnetic Resonance Imaging Scan, one area, no contrast
Magnetic Resonance Imaging Scan, one area, post contrast
RA02Z
only
Magnetic Resonance Imaging Scan, one area, pre and post
RA03Z
contrast
Magnetic Resonance Imaging Scan, two - three areas, no
RA04Z
contrast
Magnetic Resonance Imaging Scan, two - three areas, with
RA05Z
contrast
RA06Z Magnetic Resonance Imaging Scan, more than three areas
Magnetic Resonance Imaging Scan, requiring extensive
RA07Z
patient repositioning and/or more than one contrast agent
153
182
207
22
193
213
271
279
29
CT Tariff
HRG
code
HRG name
Computerised Tomography Scan
RA08ZComputerised Tomography Scan, one area, no contrast
Computerised Tomography Scan, one area with post
RA09Z
contrast only
Computerised Tomography Scan, one area, pre and post
RA10Z
contrast
Computerised Tomography Scan, two areas without
RA11Z
contrast
RA12ZComputerised Tomography Scan, two areas with contrast
Computerised Tomography Scan, three areas without
RA50Z
contrast
RA13ZComputerised Tomography Scan, three areas with contrast
RA14ZComputerised Tomography Scan, more than three areas
2012-13
Cost of
tariff
reportin
(including
g
the cost of
2012-13
reporting)
(£)
(£)
87
100
108
20
117
130
123
144
156
28
HRG
code
HRG name
Dexa
Scan
RA15Z Dexa Scan
Contrast Fluoroscopy Procedures
RA16Z Contrast fluoroscopy Procedures less than 20 minutes
RA17Z Contrast fluoroscopy Procedures 20 - 40 minutes
RA18Z Contrast fluoroscopy Procedures more than 40 minutes
Ultrasound Scan
RA23Z Ultrasound Scan less than 20 minutes
RA24Z Ultrasound Scan more than 20 minutes
Nuclear Medicine
RA35Z Nuclear Medicine - category 1
RA36Z Nuclear Medicine - category 2
RA37Z Nuclear Medicine - category 3
RA38Z Nuclear Medicine - category 4
RA39Z Nuclear Medicine - category 5
RA40Z Nuclear Medicine - category 6
RA42Z Nuclear Medicine - category 8
Simple Echocardiogram
RA60Z Simple Echocardiogram
2012-13
Cost of
tariff
reportin
(including
g
the cost of
2012-13
reporting)
(£)
(£)
69
11
90
117
166
47
63
150
162
203
358
315
288
671
57
19
26
55
BPTs & imaging
• Stroke: timely brain imaging inc report
•
•
•
•
•
•
EVAR
UAE
angioplasty and stenting (uplift for diabetics)
thoracic EVAR
TIPS
vacuum assisted breast lump excision
HRG
code
RC12A
RC12B
RC12C
RC12D
RC12E
RC13A
RC13B
RC13C
RC13D
RC13E
HRG name
Best
BPT
practice
name
tariff (£)
Infrarenal or aortio-uniilac endovascular stent-graft for nonruptured abdominal aortic aneurysm, one branched stent graft
Infrarenal or aortio-uniilac endovascular stent-graft for nonruptured abdominal aortic aneurysm, one fenestrated stent
graft
Infrarenal or aortio-uniilac endovascular stent-graft for nonruptured abdominal aortic aneurysm, one stent graft
Infrarenal or aortio-uniilac endovascular stent-graft for nonruptured abdominal aortic aneurysm, two stent grafts
Infrarenal or aortio-uniilac endovascular stent-graft for nonAbdo
ruptured abdominal aortic aneurysm, three or more stent
minal
grafts
EVAR
Other endovascular stent-graft for non-ruptured abdominal
aortic aneurysm, one branched stent graft
Other endovascular stent-graft for non-ruptured abdominal
aortic aneurysm, one fenestrated stent graft
Other endovascular stent-graft for non-ruptured abdominal
aortic aneurysm, one stent graft
Other endovascular stent-graft for non-ruptured abdominal
aortic aneurysm, two stent grafts
Other endovascular stent-graft for non-ruptured abdominal
aortic aneurysm, three or more stent grafts
BPT applies to:
BPT
Flag
HRG or
(see
sub-HRG
BPT
level
Flag
sheet)
6,667
6,667
6,667
6,667
6,667
6,667
6,667
6,667
6,667
6,667
HRG
n/a
Best Practice Tariffs
HRG
code
HRG name
Interventional Radiology - Obs & Gynae - Uterine
Fibroid Embolisation
QZ01A Aortic or Abdominal Surgery with CC
RC41Z
QZ01B Aortic or Abdominal Surgery without CC
QZ15B
Therapeutic Endovascular Procedures with
Intermediate CC
QZ15C Therapeutic Endovascular Procedures without CC
QZ15B
Therapeutic Endovascular Procedures with
Intermediate CC
QZ15C Therapeutic Endovascular Procedures without CC
GB01Z Endoscopic/Radiology category 4
JA09B Intermediate Breast Procedures without CC
JA09C Intermediate Breast Procedures with Major CC
BPT name
UFE
BPT applies to:
BPT
Flag
Best
HRG or
(see
practice sub-HRG
BPT
tariff (£)
level
Flag
sheet)
2,483
HRG
n/a
sub-HRG
BP23
sub-HRG
BP24
sub-HRG
BP25
5,674 sub-HRG
1,039
1,088
BP26
sub-HRG
BP27
6,667
Thoracic EVAR
3,965
Angioplasty and
stenting of SFA
or iliac artery for
PAD
1,769
Angioplasty or
stenting for
diabetic foot
disease
1,999
TIPS
Vacuum
assisted
percutaneous
excision of
JA09D Intermediate Breast Procedures with Intermediate CC
benign breast
1,368
1,598
1,064
Cost reduction in imaging
•
•
•
•
•
•
•
PACS
Speech recognition dictation
Skill mix: so radiologists only do what only they can do!
Efficiency, lean, 6-sigma etc
7 day/24/7
Teleradiology?
Demand management?
Tools to effect change
•
•
•
•
•
Accurate data: activity, capacity, reporting times
Evidence from professional publications
Guidelines: NICE, collegiate etc
Official reports: NAO, NCEPOD, CQC, Francis etc
Policy drivers, eg: Commissioning, Stroke Strategy,
Cardiac networks, Cancer reforms, Paediatric services
and ↑ birthrate etc etc
• Communication within trusts: clinical & managerial → £!
• Communication with commissioners → £!
Hidden imaging services
one cardiac patient . . . 10-day hospital stay . . .
…….six departments . . . 105 healthcare professionals
Scan
ECG
Echo/Contrast
Catheter
Anaesthesia
Monitoring
Ventilation
“Be ambitious – you can’t
take two steps over a gap”
David Lloyd George