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Professor Phil Gishen presentation from seven day working in diagnostics event, 4 March 2013 #7dayDiagnostics
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Teleradiology: Technology and
innovation supporting improvement
Seven-Day Services supporting
Improved Outcomes in Prevention
and Early Diagnosis
The Hotel Russell, Bloomsbury, London
4th March 2013
Problems
•DGH radiologists on call
•Immediacy of reports – brain
and heart attack centres
•Back Log
•Unreported films
•Computer generated Junk
Report
•Poor RIS connections
•HL7 in/out
•Growth of radiology CT/MR
•24/7 hospitals
•Sub specialisation
•Radiographer reporting
•“Counting”
Solutions
•Hammersmith/Charing Cross
Solution
•“Usual” method
•Watford method
•Separate radiography from
radiology
Solutions
•How many should you
report
•Cricket example
•Gishen Ready Reckoner
05/0
3/20
13
6
Bowling averages
Sir Wes Hall
Competition Test
Matches 48
Runs scored 818
Batting average 15.73
Top score 50
Wickets 192
Bowling average 26.38
Best bowling 7/69
Batting and fielding averages
Sir Leonard Hutton
Mat Runs HS
Test 79 6971 364
First
Class
513 40140 364
Average
56.67
55.51
Batting and fielding averages
Sir Denis Compton
Mat Runs HS
Test 78 5807 278
First Class 515 38942 300
Average
50.06
51.85
Gishen’s Ready Reckoner
Is your work output sufficient?
Average no. of
cases for the
year
Checking
SpR
report CT/MR Cardiac MRUS Reporting Intervention Complex
Super
complex Neuro Coil
Per hour 100 100 40 100 600 40 20 10 5
Barium Nuc Med PET CT
SPECT
CT / LT
Therapy Screening Sympto
60 100 40 5 600 200 40
KEY
* Assume you work 40 weeks in the year (leaving 12 weeks for leave, study leave, illness, meetings, machine breakdown or non function)
* You are contracted to work 30 clinically related hours (+3 hours [10%] for private work)
* Use your work output and calculate 'value for money' ie does 33 hours of timetabling per week, match your yearly statistics?
* Example - you are expected to do an aaverage of 2.5 CT or MR reports per hour -average 2.5 CT or MR reports per hour
Therefore: 1 hour x 40 weeks is 2.5 x 40 = 100 reports
So: If you report 500 CT and 400 MR scans (900) this is equivalent to an average of 9 hours of work per week
during your year's work. Average salary per consultant including on costs to Trust +120,000 per year
Breast
Sypto+U/S+biopsy
� 3000 CT reports = 30 hours of timetable per year
Average salary of consultant and all the added costs = £120,000pa
∴ Divide 3000 into £120,000 = £40 ∴ Divide 3000 into £120,000 = £40 ∴ Divide 3000 into £120,000 = £40 ∴ Divide 3000 into £120,000 = £40 per scanper scanper scanper scan
� Now add in the total time spent on MDTs for each of the medical staff to get your grand total of clinical
hours worked.
A maximum of ¼ of your weekly
hours for MDT activity
Still maybe short on
reporting capability?
•Four options:
�Increase staff
�Locums
�Insource
�Outsource
What department can produce a consultant report on an A&E
examination within 30 minutes at 0300hours on a regular basis?
NONE ?
Possible in a digital outsourced world
It is not sending films out of
your department, rather
bringing in a reporting
resource into your
department
Just like a locum
radiologist with
resilience
In-sourcing –vs- Outsourcing
Misses the point
Embrace outsourcing and it
becomes in-sourcing except
not confined to the bricks and
mortar of a hospital
Virtual Reporting
Network
Radiologists’ perception of
clinicians
•Need to know us
•Like us
•Respect us
•Have relations with us
•Give feedback
•Ask us questions
•Get advice from us
Clinicians perception of
radiologists
•Use radiology departments and
radiologists like toilets – use the first
one available
•No loyalty
Clinicians perception of
radiologists
•What do I get in return for
sending you the case?
•Don’t need your advice
•Someone to practice lies on
•Will desert radiologist at first
opportunity as suits them
THE NEW WORLD
•Phone
COSTS OF SETTING UP AN
INSOURCING
AND OUTSOURCING
PRACTICE
•Secretariat
•Accommodation, heat lights,
electricity…..coffee
• Timetables, holidays, sickness
• Statistics
•Tenders and Pricing
•Distribution of money
•Innovation and replacement of
equipment
•Development
•Premises
•Manager
•IT and IT Links
•Voice recognition
IT maintenance
IT Update
IT goes down – who
repairs/response time
•Telephone and answering
•Secretariat
•Complaints and resolution
•Double reporting
•Cleaning services and toilets
•All radiologists of a single
department involved (ha ha –
joke! ) )
•Radiology jealousy
•Vendettas
Teleradiology is not the
enemy
Like any
newborn
it needs to
be
nurtured