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Inefficiencies in A&E scan reporting waste hours of precious clinical time

It’s no secret that there is an enormous shortfall in the radiologist workforce, but the consequences of this are often badly understood. Medical advances have meant that there has been a rapid increase in the number and complexity of scans but not enough radiologists to report them. This leads to serious real-world consequences for the patients who are left waiting for diagnosis and treatment.

Days, hours, and minutes matter hugely when it comes to diagnosis, and delays prevent early treatment and lead to poorer outcomes. Studies have shown that bottlenecks in imaging result in unnecessary patient deaths, and imaging in A&E departments is known to be a particular source of delay. A CQC review of radiology services in England found that the time it takes for a scan to be reported in A&E ranges from an hour to 48 hours.

For years, healthcare systems have relied on outsourcing some of their scan reporting to teleradiology providers to boost their capacity. The RCR estimates that 91% of NHS Trusts and Health Boards outsource a proportion of their scans, and this is particularly common for emergency work because there simply isn’t the capacity for enough radiologists to be on call out of hours.

However, systems to manage this outsourced scan reporting for emergency work are often outdated, relying on phone and paper-based systems to coordinate and track reporting. Doctors and radiologists alike know that common problems with the current systems include long referral processes, diagnostic delays, poor visibility of patient progress, opaque clinical governance and poor-quality clinical information resulting in reporting discrepancies.

Some of the most common issues with on-call scan reporting through teleradiology include:
• Reliance on telephone requests, resulting in substantial delays in patient. Clinicians have reported needing up to 30 minutes on the phone for a single teleradiology referral.
• Minimal or inaccurate documentation as a result of telephone communication, resulting in poor governance in vetting requests and increased risk of unnecessary radiation exposure to patients.
• Non-transparent communication between teams which hinders effective collaboration, resulting in delays and negatively impacted patient outcomes.
• Poor visibility of imaging request progress which impairs clinicians’ ability to effectively plan the management of their patients, reducing patient flow within the department and causing delays in diagnoses and treatment.

To put just one of these issues in context, in a typical emergency department there are approximately 30 referrals per 14-hour out-of-hours session. If clinicians require 30 minutes on the phone for each one of these referrals, that results in 15 hours of wasted clinician time per night. During a fully staffed session, this equates to 1.5 hours per doctor.

As A&E departments continue to be stretched to the limit, anything that holds up a clinician for up to 30 minutes will slow down patient flow and mean that consultations and operations grind to a halt. Ultimately, all of this leads to poorer care and outcomes for the patient.

With no end to the radiologist shortage in sight, the NHS and other healthcare systems across the world are going to need to continue to outsource a proportion of their scan reporting, especially for emergency departments. However, the inefficiencies in the current systems not only lead to higher costs but unnecessary delays.

There has been a lot of talk from NHS leaders and the UK Government about using digital technology to drive up efficiency, but we have not yet seen wide-scale implementation. The technology exists to fully digitise on-call scan reporting, and the potential benefits for emergency departments and patients are huge, so we need to raise awareness amongst NHS leaders and demand more investment to change the status quo.

The Hexarad Thought Leadership Institute will be holding a roundtable discussion, “Improving Performance in ED: How improvements in diagnostics can help”, focusing on the issues facing radiology in Emergency Departments on Wednesday 6th March 2024. If you would like more information about attending this event, please email enquiries@hexarad.com

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