Waiting times in hospital x-ray departments have fallen significantly in the UK, for some tests by 33 per cent, says a Healthcare Commission report. But two out of three clinicians say that often they still do not get the results when they need them. Waiting times in hospital x-ray departments have fallen significantly in the UK, for some tests by 33 per cent, says a Healthcare Commission report published on Monday. But two out of three clinicians say that often they still do not get the results when they need them. The report from the healthcare watchdog on imaging services praises the progress made by acute and specialist National Health Service (NHS) trusts in reducing waiting times. But it also highlights major differences in performance across the country, including the length of time it takes trusts to formally report the results of the tests. An Improving Picture? Imaging Services in Acute and Specialist Trusts is the first of three reports from the Healthcare Commission, which together present a comprehensive assessment of diagnostic services in England during the period 2005/6. The Commission reviewed the performance of imaging departments using data from all 196 imaging departments in England and a survey of 5,500 doctors and nurses. Imaging departments carry out 33 million patient examinations in England each year, including x-rays, CT scans, MRI scans and ultrasound scans. Despite rising demand, most imaging departments have significantly reduced long waits for diagnostic examinations. For example, the average length of time for a non-urgent CT scan dropped from seven weeks in 2001 to just over five weeks at the end of 2005. For MRI scans, the wait reduced from 21 weeks to 14 weeks over the same period. Investment in new equipment and higher productivity levels have contributed to the improvement. The Department of Health has stipulated that, from this month, all diagnostic tests should be done within 13 weeks of referral. This is to help trusts meet the 18-week referral to treatment target by the end of 2008. At the end of 2006, 46 trusts out of 153 had already met the 13 week target for imaging services in full. However, in many trusts the subsequent wait for the result of the examination to be formally reported to the referring doctor had not improved since 2001. One in four trusts took over ten days to report examinations requested from outpatient clinics, a significant duration in the context of the 18 week referral to treatment target. And in a survey of 5,500 doctors and nurses conducted as part of the review, two out of three respondents disagreed with the statement “radiology reports are always available by the time that we need them.” One half of the respondents said that imaging problems impact daily on patient care decisions. The report states that the results from almost 10 per cent of imaging examination were never formally reported to the referring doctor by the x-ray department. This put patients at risk of having injuries or serious conditions that go undetected. Trusts should have formal agreements in place stating who will report different types of examination and how quickly. The high workload of some departments has contributed to the delays in formally confirming results. The Healthcare Commission report reveals that there are major differences between trusts in rates of referral for imaging. For example, one in ten imaging departments received more than 615 referrals from A&E per thousand A&E attendances while in other trusts the figure was less than 310. The clinical justification for such large differences should be examined critically with a view to spreading best practice on appropriate requesting of examinations. All imaging departments need facilities and policies for dealing with potentially vulnerable patients. Over half of those that examine children did not have a consultant (or an advanced practitioner) with responsibility for paediatric radiology. Three out of five did not have protocols for how uncooperative children could be examined safely and with the least distress. Anna Walker, Chief Executive of the Healthcare Commission, said: “It’s impressive that most trusts have reduced how long patients have to wait for an imaging examination, such as a CT or MRI scan. Patients can experience unnecessary worry when there are long delays waiting for a diagnosis to be confirmed. “However, the fact that the results from ten per cent of imaging examinations are never formally reported means that injuries and serious conditions can go undetected, and this potentially puts patients at risk. “The results of this review have been reported back to individual trusts so where there is a problem, they can address it. We will also be asking the relevant strategic health authorities to follow up this issue. Investment in new equipment has been a major factor in reducing waits. In 2005, there were 39 per cent more MRI scanners and 23 per cent more CT machines than in 2001 and less of the equipment in use had exceeded its recommended life. However, provision of equipment varied in different parts of the country: there were 25 non-obstetric ultrasound machines per million people in Yorkshire and Humberside compared to just 15 in the East of England. The report also notes the recent major investment in picture archiving and communications systems (PACS) that should help to improve the speed and quality of reporting in future, provided that these and other IT systems are fully utilised. On average, each radiographer carried out five per cent more examinations in 2005 than in 2001. Many have also extended their roles. But radiographers in some hospitals perform more than twice as many examinations a year, after taking account of complexity of case-mix, as those in others. The report recommends that imaging departments should continue to review skill mix in the light of changes in demand, roles, equipment and processes and ensure that reasons for abnormally high or low productivity or unit costs are understood and justified. These reviews should include comparisons with other similar trusts. Such comparisons would be easier if national agreement were reached on whether scans that include several views or which use a contrast medium should be counted as a single examination or as many. The full report can be downloaded from http://www.healthcarecommission.org.uk/acutehospitalportfolio Source: Healthcare Commission