DEMAND ON IMAGING SERVICES - csnlc.nhs.uk · DEMAND ON IMAGING SERVICES Russell Dineley ... • RPH Extended 12 hour days Monday to Friday ... urgent/next available slot.

IMAGING IN ACUTE STROKEIMAGING IN ACUTE STROKE

DEMAND ON IMAGING SERVICESDEMAND ON IMAGING SERVICES

Russell DineleyRussell DineleyPrincipal RadiographerPrincipal Radiographer

Cross Sectional ImagingCross Sectional Imaging

STATISTICSSTATISTICS

PopulationPopulation

•• 370,000 people in Chorley, South Ribble and 370,000 people in Chorley, South Ribble and PrestonPreston

•• Approaching 2 million people in Lancashire & Approaching 2 million people in Lancashire & South CumbriaSouth Cumbria

Prevalence of StrokePrevalence of Stroke•• 2.3%2.3%

ACTIVITY & DEMANDACTIVITY & DEMAND20082008--0909

•• 18,500 CT Scans compared with 16,800 in 2007/08 18,500 CT Scans compared with 16,800 in 2007/08 •• Year on Year Increase of 10%Year on Year Increase of 10%

•• (38% Brain scans)(38% Brain scans)

•• 15,500 MRI Scans compared with 12,500 in 2007/0815,500 MRI Scans compared with 12,500 in 2007/08•• Year on Year Increase of 24%Year on Year Increase of 24%

•• (36% Brain scans)(36% Brain scans)

MODALITIESMODALITIES

ROYAL PRESTONHOSPITAL

SIEMENS 1.5TMRI SCANNER

PHILIPS 64 SLICE CT SCANNER

SIEMENS 1.5TMRI SCANNER

SIEMENS 10 SLICECT SCANNER

MODALITIESMODALITIES

CHORLEY DISTRICTHOSPITAL

SIEMENS 1.5TMRI SCANNER

SIEMENS 16 SLICECT SCANNER

SCANNER FUNCTIONALITYSCANNER FUNCTIONALITY

RPHRPH•• CT ANGIOGRAPHYCT ANGIOGRAPHY•• CT PERFUSIONCT PERFUSION

•• MRI DWIMRI DWI•• CEMRACEMRA

CDHCDH•• CT ANGIOGRAPHYCT ANGIOGRAPHY

•• MRI DWIMRI DWI•• CEMRACEMRA

STAFFINGSTAFFING

RPH:RPH:•• Dedicated team of CT/MRI/NeuroDedicated team of CT/MRI/Neuro--intervention intervention

Specialist radiographersSpecialist radiographers•• On call from HomeOn call from Home•• Compensatory restCompensatory restCDH:CDH:•• General radiographers rotate in CTGeneral radiographers rotate in CT•• Evening/Night staff cover On CallEvening/Night staff cover On Call

CAPACITYCAPACITY

MRI:MRI:•• RPH Extended 12 hour days Monday to FridayRPH Extended 12 hour days Monday to Friday•• CDH scanner 8:30CDH scanner 8:30--4:304:30

Current Total capacity= 186 hours p/weekCurrent Total capacity= 186 hours p/week(This includes additional capacity by external providers, (This includes additional capacity by external providers,

DoH contract, WLI & good will of staff)DoH contract, WLI & good will of staff)

Capacity Required=211 hours p/weekCapacity Required=211 hours p/week

CAPACITYCAPACITY

CT:CT:•• RPH Extended 12 hour days Tues/Wed RPH Extended 12 hour days Tues/Wed

•• CDH Extended daysCDH Extended days

Current Total capacity= 121 hours p/weekCurrent Total capacity= 121 hours p/weekCapacity Required=126 hours p/weekCapacity Required=126 hours p/week

CURRENT ISSUESCURRENT ISSUES

•• CT on call staff not on site 24/7CT on call staff not on site 24/7•• Compensatory restCompensatory rest•• Current general radiographers not all adequately Current general radiographers not all adequately

CT trainedCT trained•• CT LocationCT Location

•• MRI capacity shortfallMRI capacity shortfall

National Stroke StrategyNational Stroke Strategy

Stroke:Stroke:•• Approx 19 patients per weekApprox 19 patients per week•• Virtually ALL will require CT/MRI. >half as Virtually ALL will require CT/MRI. >half as

urgent/next available sloturgent/next available slot

Current Evidence & AuditCurrent Evidence & Audit

Stroke:Stroke:•• 10 week cross site audit10 week cross site audit•• 89 patients referred for scan89 patients referred for scan•• Time of PresentationTime of Presentation•• Time of admission to CT scan Time of admission to CT scan •• Scans performed within 24 hoursScans performed within 24 hours•• Written request/direct orderWritten request/direct order•• Scan time to reportScan time to report

Presentation (Time of Day)

0

2

4

6

8

10

00:00

02:00

04:00

06:00

08:00

10:00

12:00

14:00

16:00

18:00

20:00

22:00

Time (24 hours)

Patie

nts

Patients

Time of admission to CT scan

05

1015202530354045

24 ho

urs2 d

ays

3 day

s4 d

ays

5 day

s6 d

ays

7 day

s8 d

ays

9 day

s10

+ day

s

Admission to scan (Days)

Pat

ient

s

Patients

Percentage of Scans performed in 24 Hours (From Presentation)

53%47%

Scans done in 24 hours

Scans not done in 24hours

PRESTON: Percentage of Scans Performed in 24 Hours (referral to scan)

16%

84%

Scans done in 24 hours

Scans not done in 24hours

CHORLEY: Percentage of Scans Performed in 24 Hours (referral to scan)

45%55%

Scans done in 24 hours

Scans not done in 24hours

Sentinel auditSentinel audit

‘‘Brain Scan within 24 Hours of strokeBrain Scan within 24 Hours of stroke’’

20062006•• Both sites below national average of 42%Both sites below national average of 42%

20082008•• RPH above national average (71%)RPH above national average (71%)•• CDH below national average (16%)CDH below national average (16%)

ConclusionConclusion

CT:CT:•• Improve CDH Sentinel audit resultImprove CDH Sentinel audit result•• CT staff trained to perform brain scans on site CT staff trained to perform brain scans on site

until midnight (RPH)until midnight (RPH)•• Develop this service to 24/7 Develop this service to 24/7 •• Shifts rather than OCShifts rather than OC•• Insufficient capacityInsufficient capacity-- Extended days?Extended days?•• Complex CT PerfusionComplex CT Perfusion……ThrombolysisThrombolysis

MRI:MRI:•• Insufficient capacity. 12 hour Insufficient capacity. 12 hour

days/Weekend working cross site.days/Weekend working cross site.•• Additional capacity requiredAdditional capacity required-- 44THTH MRI MRI

SCANNER??SCANNER??

AcknowledgmentsAcknowledgments

Miss Kelly White, Specialist RadiographerMiss Kelly White, Specialist Radiographer

Any Questions?Any Questions?