Practical principles for improving access to CT scanning One of a set of eight practical principles publications. The full set are: 1 - Improving psychological care after stroke 2 - Developing an early supported discharge service 3 - Improving access to CT scanning 4 - Transient Ischaemic Attack (TIA) 5 - How to establish joint care planning 6 - How to manage reviews for stroke survivors 7 - Being the best in acute stroke 8 - Developing a community stroke service (Published November 2011)

1. NHS
NHS Improvement
PRACTICAL PRINCIPLES
for improving access to CT scanning
1. Review and streamline the existing pathway
2. Involve all members of the team
3. Train radiology staff
4. Introduce simple, but effective, changes to ensure best
practice QUALITY 7,8 ACCELERATING
MARKER &9 STROKE
IMPROVEMENT
4
Review and streamline the
existing pathway
• Map out the existing patient
pathway and identify all the key
steps
• It is important to involve all members
of the team in order to provide a
comprehensive overview of the
entire pathway
• Identify areas where delays are
occurring and where wasteful steps
can be removed
• Encourage the use of protocols so
that radiographers are able to accept
requests directly, rather than the
clinician having to discuss with a
radiologist
• Review off site on call systems – CASE STUDY CASE STUDY
these often cause measurable delays
Royal Bournemouth and Salford Royal Hospital NHS
out of hours. Departments are now
Christchurch Hospitals NHS Foundation Trust implemented a
moving towards extended days and
Foundation Trust introduced a comprehensive stroke imaging
the provision of a full 24 hour
rapid access to CT service using service and trained their stroke
service.
ambulance paramedic staff. unit nurses to request both
acute and 24 hour thrombolysis
follow up CT scans.
CASE STUDY
Hull and East Yorkshire Involve all members of the team
Hospitals NHS Trust moved
away from an off site on call • Involve all members of the team who • Many stroke services are now
service and have implemented a have input into the stroke pathway, coordinated by a stroke nurse
24 hour CT service, reducing as often you are not aware of how specialist or stroke coordinator. A
patient pathway times. the pathway works outside of your number of trusts have introduced
own department stroke nurse specialist CT brain
• All trusts should have a single stroke requesting to reduce delays in
strategy, so team members are easily patient pathways and improve access
able to follow the correct protocol times to the scanner.
• Encourage attendance at
multidisciplinary team meetings, so
all staff working within the pathway
can raise and discuss issues and look
at new ways of working

2. NHS
NHS Improvement
Train radiology staff Introduce simple, but effective, Two publications are available to
changes to ensure best practice support access to scanning for stroke:
• Review the skill mix currently
available and identify areas for • Use the existing bleep system for • ‘Why treat stroke and transient
training trauma or medical emergency and ischaemic attacks (TIAs) as
• Ensure all staff are aware of the introduce a FAST positive call for emergencies?’
clinical benefits of scanning patients potential thrombolysis patients • ‘A guide to achieving changes in
with a suspected stroke within 24 • Review the booking process – often imaging services to support new
hours, or in urgent cases within one patients can be scanned on-route to stroke pathways.’
hour the ward, negating the need for
• All radiographers are capable of additional transfers To access the above publications and
carrying out basic CT brain scans • Sign up to a digital image transfer for more information and case
with minimal training, and can system so diagnostic information studies, please visit the NHS
increase the resource pool available can be shared effectively and safely Improvement website:
• Use competency based training tools between trusts locally. www.improvement.nhs.uk/diagnostics
and ensure these competencies are
regularly reviewed
• Produce a detailed, step by step
SINAP (the Stroke
guide for staff on how to perform a
Improvement National Audit
CT brain scan and instructions on
Programme) collects data on
how to use the equipment
imaging which can be used
• A large number of radiographers are for the Accelerating Stroke
now trained to report CT brain scans Improvement measure. Check
providing a quicker response for if your trust collects data for
stroke patients SINAP.
CASE STUDY
The Great Western Hospitals
NHS Foundation Trust
implemented a training program
so that all radiographers
working out of hours were able
to perform a CT brain scan.
CASE STUDY
Kingston Hospital NHS Trust
use their CT head reporting
radiographers to vet all
requests, decide on appropriate
use of contrast and report final
images.
ACCELERATING
STROKE IMPROVEMENT