The need to address the NHS' shortage of radiologists is widely recognised in England, where unmanageable workloads are said to be adding more strain on a workforce already spread too thin.

One organisation that has experienced increasing demand on services is Princess Alexandra Hospital NHS Trust (PAHT), located in the south-east, where the radiology department has seen a 10% year-on-year increase in imaging referrals.

The trust, established in 1965, looks after a local population of over 350,000 people, operating across three sites, the Princess Alexandra Hospital, St Margaret’s Hospital and Herts and Essex Hospital.

In 2017, with its existing contract up for renewal, a team set out to procure a new Picture Archiving and Communication System (PACS), wanting to iron out some of the challenges staff were facing, from poor interoperability to a lack of quality control and more.

“The imaging system is key to an A&E environment and the running of a hospital,” Stephen Townrow, imaging systems manager at the trust, told Healthcare IT News on a site visit earlier this month. “We viewed literally dozens of demos, and some were good, some were okay, but certainly that was an interesting experience. We had a clear set of requirements for what we wanted to achieve.”

In October 2017, after four vendors were invited to tender, a five-year contract was signed with Agfa Healthcare – also the previous supplier – for the deployment of an Enterprise Imaging for Radiology suite.

According to Agfa, the contract included EI for radiology, a scalable vendor-neutral archive, reporting and advanced clinical applications, the XERO Enterprise Viewer and business intelligence, in order to allow the hospital to access all the information needed in one platform, which went live the following April.

Getting to zero imaging backlog

The implementation is said to have made a difference to staff, patients and the wider community, a team from the trust told Healthcare IT News during the site visit.

“First of all, we found that the system is fully auditable, so we’re able to identify errors, [it] enables targeted, effective training,” said Jack Oakes, senior interventional radiographer and PACS administrator. “If we find that a radiographer, for example, is making an error multiple times, we can identify that quite quickly and see if there is any training that we can provide to improve that.”

“Because I’m able to alert the team more or less live, it’s so much easier to resolve [these issues],” added Dr Sandra Dimmock, consultant radiologist and former medical director at the trust.

The system also allows radiologists to personalise the display of information depending on the type of work being carried out. “It means that I can see in one glance on the screen everything I need to know about that patient. I don’t have to go anywhere else, and that’s made a huge difference,” Dimmock explained.

“In the past, we could only do about five [plain film reports] in a minute, and that’s due to a combination of things, usually the time it took to load, if you’re looking for previous investigations and so on and so forth. None of that happens now. It’s all instant.”

As a result, the trust has zero imaging backlog. “This morning, sitting there, there are 30 waiting to be reported, and that is it [of plain films]. It means that there is less need to recall patients,” Dimmock said. “If you can catch the problem before they’ve left that department, which sometimes happens, that’s wonderful, and of course it’s great for the patient. You know, elderly patients … you don’t want to have them come back again if you can manage it.”

Tackling increasing pressures on A&E

In her role as medical director for the trust for a number of years, Dimmock said she realised there was a growing need to address pressures on A&E.

“Patients know that if they come to A&E, they by and large get things sorted out as they come, so the temptation to them is, especially if it’s difficult to access primary care, to do that,” she explained. “My rationale was, when I came back to radiology reporting, that if we can give the GPs as close a service, not identical, but as close a service as possible to what they get from if the patient turns up at A&E, then we have more chance of them going to the GP and having their examinations than turning up at A&E and getting things done.

“So that was my aim, because if the GPs are being asked to do this, to stop patients attending A&E, we have to give them the support that enables them to do that. And that was the fundamental reason for me trying to do this,” she explained.

Now, the hospital can provide GPs with reports within 24 hours, compared to up to three weeks previously. All staff are using voice recognition technology, which has led to improvements in report turnaround times, while doctors can use iPads on wards to show patients their scans.  

The team says the deployment has played a key role in the trust scoring among the top NHS organisations in the country in a review of radiology reporting standards, published earlier this year. PAHT was placed second in England for the proportion of images reported within the 24-hour target for inpatient services, and sixth when looking at the number of emergency department images reported within the four-hour target.

“We think that we probably didn’t do better than that because ... the larger teaching hospitals have junior staff on all weekend. We have colleagues on at the weekend, but probably not in the same kind of numbers to produce that kind of turnaround for plain films,” Dimmock said.

According to Dr Sri Redla, consultant radiologist and associate medical director for cancer, cardiology and clinical support services, PAHT now plans to roll out the platform across other departments, starting with cardiology, medical imaging and theatre imaging, and look at what benefits AI could bring to the system.