The implementation of a Radiographic Reporting Service for trauma examinations of the skeletal system, in 4 National Health Service Trusts
Project Reference: SPGS 438
Project Dates: 1 September 1997 (project start) 30 November 1998 (project end)
31 March 1999: Date of report submission
Project Leader: Mr Keith Piper, Senior Lecturer and Programme Director, PgD Clinical Reporting *
Research Assistant: Ms Carol Ryan, Department of Radiography *
Project Supervisor: Mrs Audrey Paterson, Dean of Faculty of Health and Sciences and
Head of Department of Radiography *
* Canterbury Christ Church University College
Main Research Objectives
The purpose of the study was to evaluate the implementation of a Radiographic Reporting Service (RRS) in four NHS Trusts in the United Kingdom with specific reference to the reporting by radiographers of musculo-skeletal trauma examinations. The research investigated the accuracy of radiographers’ written reports in terms of sensitivity and specificity; the impact on patient care and management as measured by the volume of reporting activity undertaken and the speed with which reports became available; costs related to the implementation of an RRR, and satisfaction of the users of the service.
Methodology and Sample Size
A longitudinal study design was used to measure the productivity and effectiveness of radiographic reporting in four NHS Trusts and five clinical sites in England. Data were collected by direct measure, report pro-forma, semi-structured questionnaires and interviews. A series of base line measurements were made at the commencement of the project. These were the volume of reporting activity prior to implementation of an RRS and the speed with which the reports became available. The satisfaction of the users of the reporting service prior to the implementation of an RRS was also gauged. Three measures (volume, speed, satisfaction of users) were repeated after the RRS had been implemented. Longitudinal data on the accuracy of the radiographers’ reports in terms of sensitivity and specificity were also collected at each site. Finally, some cost information related to the introduction and provision of an RRS was gathered.
Four NHS Trusts and 10 radiographers participated in the study. Radiographers completed 10275 reports and 7179 were used to assess accuracy, sensitivity and specificity. Volume and speed data were obtained from the normal workload in each Trust. Four radiology services managers provided the cost data, while 26 staff took part in the initial survey and 12 in the final survey.
The major problem with this study was the fact that it was investigating the implementation into practice of a new and controversial service. It was beset, therefore, with the difficulties of aligning a research project to practice and this was only possible imperfectly. Points of implementation of the new service varied considerably, workload of key staff made verification of reports difficult and information systems within Trusts proved problematic.
Radiographers’ reports were accurate and consistently so over time. Significant improvements in the volume of reporting activity were found post-implementation at 2 of the 4 clinical sites in which this was measured. Additionally, the speed with which reports became available was shown to have improved significantly in all 4 NHS Trusts (but not at one clinical site). Cost data was not considered to be reliable and more evaluation of costs is required. Users of the radiographic reporting services were extremely or very satisfied with the quality of reports produced by the radiographers and also satisfied with the nature of the service implemented. Finally, a range of organisational issues were seen to affect the implementation of these services, at times quite inappropriately.
NHS Trusts that are unable to provide a full and/or timely musculo-skeletal trauma reporting service should implement a radiographic reporting service but must ensure that this is properly planned, funded, implemented and managed. Monitoring of service effectiveness and auditing of reporting standards should take place periodically.
The four collaborating NHS Trusts and their staff; Expert panel members; Members of the Steering Group; Colleagues at Canterbury Christ Church University College, and the Research and Development Directorate at South Thames Regional Office (NHSE).