Professor Phil Gishen presentation from seven day working in diagnostics event, 4 March 2013 #7dayDiagnostics

1. Seven-Day Services supporting
Improved Outcomes in Prevention
and Early Diagnosis
Teleradiology: Technology and
innovation supporting improvement
The Hotel Russell, Bloomsbury, London
4th March 2013

2. Problems
•DGH radiologists on call
•Immediacy of reports – brain
and heart attack centres
•Back Log
•Unreported films
•Computer generated Junk
Report

3. •Poor RIS connections
•HL7 in/out
•Growth of radiology CT/MR
•24/7 hospitals
•Sub specialisation
•Radiographer reporting
•“Counting”

4. Solutions
•Hammersmith/Charing Cross
Solution
•“Usual” method
•Watford method
•Separate radiography from
radiology

5. Solutions
•How many should you
report
•Cricket example
•Gishen Ready Reckoner

6. 6
05/0
3/20
13

7. Sir Wes Hall
Bowling averages
Competition Test
Matches 48
Runs scored 818
Batting average 15.73
Top score 50
Wickets 192
Bowling average 26.38
Best bowling 7/69

8. Sir Leonard Hutton
Batting and fielding averages
Average
Mat Runs HS
56.67
Test 79 6971 364
First 513 40140 364 55.51
Class

9. Sir Denis Compton
Batting and fielding averages
Average
Mat Runs HS
Test 78 5807 278 50.06
First Class 515 38942 300 51.85

10. Gishen’s Ready Reckoner
Is your work output sufficient?
Average no. of Checking
cases for the SpR Super
year report CT/MR Cardiac MR US Reporting Intervention Complex complex Neuro Coil
Per hour 100 100 40 100 600 40 20 10 5
Breast
SPECT
CT / LT
Barium Nuc Med PET CT Therapy Screening Sympto Sypto+U/S+biopsy
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 ofCT or MR reports per hour hour -
average 2.5 2.5 CT or MR reports per
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
3000 CT reports = 30 hours of
Now add in the total time spent on
timetable per year
MDTs for each of the medical staff
to get your grand total of clinical
Average salary of consultant and
hours worked.
all the added costs = £120,000pa
∴ Divide 3000 into £120,000 = £40
A maximum of ¼ of your weekly
per scan
hours for MDT activity

11. Still maybe short on
reporting capability?
•Four options:
Increase staff
Locums
Insource
Outsource

12. 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

13. It is not sending films out of
your department, rather
bringing in a reporting
resource into your
department

14. Just like a locum
radiologist with
resilience

15. 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

16. Virtual Reporting
Network

17. 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

18. Clinicians perception of
radiologists
• Use radiology departments and
radiologists like toilets – use the first
one available
• No loyalty

19. 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

20. THE NEW WORLD
•Phone
•Email
•Twitter
•Facebook

21. COSTS OF SETTING UP AN
INSOURCING
AND OUTSOURCING
PRACTICE

22. •Secretariat
•Accommodation, heat lights,
electricity…..coffee
• Timetables, holidays, sickness
• Statistics

23. •Tenders and Pricing
•Distribution of money
•Innovation and replacement of
equipment
•Development

24. •Premises
•Manager
•IT and IT Links
IT maintenance
IT Update
IT goes down – who
repairs/response time
•Voice recognition

25. •Telephone and answering
•Secretariat
•Complaints and resolution
•Double reporting
•Cleaning services and toilets

26. •All radiologists of a single
department involved (ha ha –
joke! ) )
•Radiology jealousy
•Vendettas

27. Teleradiology is not the
enemy
Like any
newborn
it needs to
be
nurtured