Ground-breaking joint venture for UCLH imaging services

Urgent diagnostic images are winging their way from London to Australia throughout the night in a ground-breaking venture between UCLH and a leading provider of remote imaging services.

UCLH has teamed up with Imaging Partners Online Ltd (IPO) in a venture, which provides a rapid, round-the-clock reporting system and improved efficiency.

It means a 24/7, 365-days-a-year imaging reporting service, which is available to hospitals across the UK and could eventually include hospitals in Europe and the Middle East.  This NHS joint venture is known as Radiology Reporting Online (RRO) and provides daytime, after hours, urgent, and locum reporting of diagnostic images.

Hospitals across the NHS and globally can access radiology expertise in specialities where they have none, for example neuroradiology.

Dr Charles House, divisional clinical director for UCLH's imaging services, said: "This means that UCLH and clients of RRO will have a seamless, 24/7 imaging service, which is of the highest quality, drawing on IPO’s proven radiology reporting systems and UCLH’s expertise."

The impact of RRO on the imaging department at UCLH has contributed to a transformational change. Outpatient CT scans which were taking, on average 26 days from exam to report in January 2011, are now taking around 2.5 days. The waiting time for reporting routine GP scans has been reduced from up to two weeks to 24 hours.

RRO managing director Rhiannon Williams said as well as improving quality the venture was providing greater efficiency and productivity for the NHS.

She added: “Most of our clients only have a few scans to report overnight and it is expensive to have a doctor in the hospital to report three of four urgent scans, especially when the doctor then has the next day off in order to comply with the European Working Time Directive.  Using our service will generate real cost savings for imaging departments”

At UCLH, it has meant more radiology registrars, who previously provided the out-of-hours reporting service, have been available to work during the day and at weekends – increasing the UCLH radiology department’s capacity and improving the quality of care to patients and the training of junior doctors.

RRO conducts daily audits which have indicated that the quality of the reports has remained at the highest standard.  The organisation has a strong culture of driving continuous quality improvement and the involvement of UCLH enhances this further.

Sir Robert Naylor, UCLH chief executive, said: “There were three major reasons why we went into this project. Firstly to improve productivity, secondly to speed up reporting to enable clinicians to make early diagnostic decisions and thirdly to save money.

“Innovation, enterprise and collaboration are essential if the NHS is going to meet the Nicholson Challenge. This is an example of the NHS at its innovative best, working in a commercial partnership to improve efficiency and productivity along with the quality of care for patients.

“UCLH is internationally renowned for its clinical, research and academic accomplishments, while Imaging Partners Online brings to the joint venture a proven offsite reporting service model, as well as a depth of management experience in teleradiology technology.”

Implementation of three clinical protocols dramatically improves stroke patient outcomes (National Stroke Foundation)

Acute stroke patients who receive three clinical protocols to manage fever, sugar and swallowing are 16 percent more likely to be alive and independent three months later - a collaborative research study led by Professor Sandy Middleton, National Stroke Foundation Clinical Council member and Director of the Nursing Research Institute at the Australian Catholic University and St Vincents & Mater Health Sydney has found. This research has provided critical data demonstrating significant improvements for the management of patients following stroke.

Stroke is caused by a clot or a bleed in the brain and is Australia’s second biggest cause of death and leading cause of disability. While a patient suffers irreversible brain damage as a result of the stroke, there is potential to salvage surrounding brain tissue and limit the damage by effectively managing fever, sugar and swallowing.

The NHMRC-funded trial is the first nurse-led trial in acute stroke of its kind carried out in Australia and involved 19 acute stroke units across New South Wales and more than 1,600 patients.

The trial developed, implemented and evaluated the effectiveness of team-building workshops and education to introduce three clinical protocols to manage fever, sugar and swallowing (the FeSS protocols) following an acute stroke.

“Patients admitted with an acute stroke to hospitals that were randomised to receive our support to implement these FeSS protocols, were 16 percent more likely to be alive and independent at 90 days.” Professor Middleton said.
“These results are better than any current drug or treatment for stroke including clot busting therapy, and can be universally applied in acute stroke units.”

Published online today in The Lancet, the study showed that patients who received care in stroke units using these protocols were also more likely to have fewer episodes of fever, lower average temperatures and sugar levels, and better screening for swallowing difficulties.

“We found better outcomes for patients and consistently better processes of care in these hospitals because we created opportunities for teams to come together and agree on what they could do as an integrated service to improve quality of care. These results provide some of the best evidence to date in Australia on how to change clinicians’ behaviour and also evidence for effectiveteam work and good nursing care.”Professor Middleton said.

“Good management of fever, high blood sugar levels and swallowing can salvage brain tissue - poor management however can result in extension of the stroke and have devastating consequences for the patient.”

The study was a collaboration between the Australian Catholic University, the University of Newcastle, the University of Ottawa, the University of Western Sydney, the University of Sydney and the University of Melbourne, as well as a team of clinicians from NSW Health and support from the Agency for Clinical Innovation’s Stroke Services NSW.

The National Stroke Foundation is encouraging the delivery of such programs in Australian stroke units to support the use of the FeSS protocols based on the success of Professor Middleton’s trial.

“Recovery after a stroke can be significantly improved when health professionals are supported to implement protocols that ensure consistent and prompt clinical management of these three factors – fever, blood sugar levels and swallowing. Stroke is Australia’s second leading cause of death and a major cause of disability. The delivery of programs resulting in improved care for stroke care is critical in ensuring more Australians survive stroke, and that costs associated with stroke care are minimised.” says CEO Dr Erin Lalor.

Professor Middleton said she had been delighted to find so many stroke units eager to step up and adopt best practice. “This is great news for evidence-based health care.”

Distance a killer in the bush (SMH)

A cancer diagnosis is just the latest in a series of crushing misfortunes for Garry Lyons. Following a redundancy this year - the third for the 60-year-old boiler worker - he invested the money in paying down his mortgage, only to find this left him ineligible for Centrelink payments. But a lack of any income has not protected the Wagga Wagga man from a $600 out-of-pocket payment for a follow-up scan on his prostate to assess the effects of treatment, which had to be carried out privately ... Read More

Radiology gap deprives bush patients (SMH)

RURAL and regional Australians are missing out on vital radiation services that can increase survival and recovery rates for cancer sufferers, according to radiology experts.

A survey of Australia's radiology workforce found that while the total number of radiologists across Australia has increased since 2000, less than 25 per cent of radiologists serviced a third of the population in rural and regional areas.

Professor Chris Milross, from the Royal Australian and New Zealand College of Radiologists (RANZCR), said there was a national shortfall of about 40 radiology machines.

There are also worries about the ageing population and an increasing number of future cancer cases.

Professor Milross said while it cost about $5 million to set up a machine, the benefits were enormous.

He said part of the problem was training and enticing radiologists to country areas, but the RANZCR was working to address that shortfall.

The survey was released at the RANZCR annual scientific meeting in Melbourne this weekend.

More than 1000 global experts are discussing new technologies that promise to deliver higher standards of care for Australians with cancer.

Professor Milross said half of all cancer patients could benefit from radiotherapy, but in NSW just 35 per cent received it.

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