Subject Visit to Scanning Department

RNOH PPI Forum

Scanning Department Report

Date: 27 December 2007 10.30 AM

Forum Members: Ruth Marcus and Angela O’Halloran

Interview with Manager Pauline Lodwick

Background:

As a follow-up to Pauline Lodwick’s Presentation on the introduction of the Picture Archiving and Communication System (PACS) we visited the scanning department.

The Department has 1 Computer Tomography (CT) scanner and 1 Magnetic Resonance Imagery (MRI) scanner. On the day we visited only the CT scanner was in use as the MRI scanner was being serviced.

PET scanning is not available in house as it would not be cost effective for the number of patients requiring it. The department sends these patients to Mount Vernon Hospital to be scanned, for which it pays a fee.

GPs cannot request scans directly but must refer patients to a consultant; the patient’s history is checked to prevent duplication.

Bone density scans however can be requested by GPs, the wait is approximately 5 weeks. Pauline feels that the NICE guidelines for this are too restrictive as it is only offered after osteoporosis is suspected due to fracture etc.

Waiting Time

Pauline has worked hard to ensure the scanners are used to maximise their capacity. She has fortnightly staff meetings to manage the waiting list. 90% of requests are received the day the request is made. This in itself reduces the wait considerably. Procedures are in hand to deal with the other 10% - mostly from one source.

There will be mandatory electronic requesting in March when the out patients system will be compatible with the PACS system. This will ensure all requests are received on the day of request.

At present the wait for patients with possible cancer is up to 10 days. However other conditions are offered an appointment within 18 weeks. Partial booking appointments are offered where the patient is contacted by letter to phone for an appointment. If they have not replied within 2 weeks another letter is sent requiring them to respond within 7 days, thus giving them at least 3 weeks to contact the hospital.

Patients requiring procedures under CT are given pain relief as necessary. There is a 4 week wait for diagnostic scans (government target 6 weeks) and 8 weeks for treatment scans – on target.

For patients requiring a general anaesthetic there is only one session a month as an anaesthetist is required so these patients may have to wait longer.

Waiting times are to be further reduced by using the research CT scanner when it is free. There is a new MRI scanner which is 25% quicker than the old one while also being more sensitive. It is used 12 hours a day, on weekdays from 8am to 8pm and on Saturday mornings.

Staffing

With 5 qualified radiographers Pauline feels she has adequate staffing levels and can make a case for bank staff when necessary. There is a doctor present if treatment is being carried out. Otherwise there is always a doctor available for queries. The department has its own porter and 5 wheelchairs.

Pauline feels she has a good relationship with consultants and good cooperation from them.

Staff Training

Time is made available for staff to update their knowledge both in house and externally.

Infection Control

The machines are cleaned after use and each individual has gel for hand cleaning. The uniform policy states that uniforms should be washed at home at 60°and not worn outside. The department including the WCs appeared clean.

The waiting area was adequate with sufficient seats and with WC available.

We talked to Pauline in the staff room which was less than ideal as some staff needed to use the facilities.

Patient Interviews

Mr A had been referred to RNOH by his local hospital for a biopsy of a swelling on his knee. He had previously been diagnosed with Rheumatoid Arthritis and needed to have the biopsy done under CT.

Mr A had been told he would have to wait about two weeks for an appointment but was contacted after 4 days. It was his first experience of the RNOH and he was happy with the service. His only complaint was about the distance he had to travel. He did not know whether he would have his follow up at Stanmore or at his local hospital.

Mrs B had had her knee replaced twice at her local hospital and it was still causing her problems with loose cement. She thought she was coming to RNOH to have a procedure involving cleaning her blood but found she was to have a bone scan. She was not happy with her transfer from Outpatients as there had been no wheelchairs and no porters available and she had had a difficult walk. She was also unhappy that she would possibly have to return for the other procedure

She also told us that she had a bone scan done privately 4 months previously but had not mentioned it to anybody as they had not asked.

Recommendations

Congratulations to Pauline and her staff on reducing the waiting-time from 28 to 18 weeks.

Look at only 1 general anaesthetic a month.

Cooperation with outpatient department to aid patients who have walking difficulties.

Better staff facilities.

More comfortable & interesting waiting area.

Scanning DeptPage 1 of 3Dec 07