MRI in the NHS,Malta: The effectiveness of a radiographer led unit'

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MRI in the NHS,Malta The effectiveness of a
radiographer led unit.

• Joseph Castillo B.Sc, M.Sc (HCM), M.Sc(MRI)
• St. Lukes/Mater Dei Hospital

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Brief outline of SLH/MDH

• 500 bed hospital
• 1000 employees
• 169,146 Imaging studies in 2006
• MDH fully digital

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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 (730 100pm)
• 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 patients 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 Radiographers Role in clinical
  outcomes.