Radiographer role extension: a paradigm shift in practice. S Mathers* +, G McKenzie*, + The Health...
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Transcript of Radiographer role extension: a paradigm shift in practice. S Mathers* +, G McKenzie*, + The Health...
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Radiographer role extension: a paradigm shift in practice.
S Mathers*+, G McKenzie*,
+The Health Services Research Group, The Robert Gordon University, *NHS Grampian
Aberdeen, Scotland, UK.
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Factors leading to radiographer role extension
Political
- NHS organisations are accountable for continuously improving the quality of the service
- New roles are encouraged to demonstrate innovations and (hopefully) improve quality
A First-class Service, Quality in the NHS, 1998
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Staff
‘The traditional demarcations between staff have held services
back ...the provision of health services should depend on the
ability of the staff, not their job title.’
A Health Service for All Talents – Developing the NHS Workforce, Dept of Health, 2000
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Radiology
- serious shortage of radiologists- increasing waiting lists for procedures- year on year increase of examinations performed
- additional demands on radiologist’s time
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Guidance on delegation of tasks
Medical practitioners may delegate medical care to non-medical
health care staff – but the MP must be sure that the staff are
competent ... to carry out that task.
Such health care workers must be accountable to a statutory
body, i.e. state registered.
GMC, Good Medical Practice, 1995
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www.sor.org
www.rcr.ac.uk
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Main areas of role extension
• In the areas of- GI, e.g. radiographer performed barium enemas - Ultrasound, e.g. general diagnostic US, O&G
• Intravenous injections of contrast media- IVU, CT, nuclear medicine
• Reporting of images- skeletal, US, GI, nuclear medicine, mammography,
• Angiography, e.g. peripheral angiograms
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Training
• Initially hospital based – e.g. St James’ Leeds Barium Enema Course
• Courses now University led– e.g. Salford University
• You must have a supportive and enthusiastic radiologist
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Requirements between Dept and Hospital Management
Letter of agreement of radiographer role extension
- task(s) delegated
- to whom delegated
- who is responsible
- name(s) of radiographer(s) involved and training
- name(s) of supervising radiologist(s)
Signed by clinical manager and Hospital Manager
Radiographer must be insured
- Trust Indemnity Insurance AND
- Personally (usually through SoR)
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Radiographers experience of performing barium enemas
The main aims were to:
- determine characteristics of radiographers who performed BE
- establish current practices
- ascertain benefits and drawbacks of performing BE
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Study design
Sample
- convenience sample of 68 radiographers (GIRSIG members)
Postal questionnaires- total of 20 questions (17 closed)
- in 3 sections
performing BE
other duties
personal information
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Results
71% response rate
(n=48/68)
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Characteristics
• mean age 43 years
(range 25-56 years)
• 76% (n=34) female• 24% (n=11) male 0
5
10
15
20
25
20 -29 years 30 -39 years 40-49 years 50-59 years
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Motivation
0
10
20
30
40
50
60
70
80
90
100
Increased jobsatisfaction
New challenge Increased personalautonomy
Increased patientcontact
%
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% of total BE performed by radiographers in their department
% n
more than 80% 47 21
50% - 80% 33 15
less than 50% 20 9
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Reporting
• 16% (n= 7) reported own enemas without input from radiologists
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Performing other fluoroscopy procedures
0
10
20
30
40
50
60
ERCP Bariumswallw/meal
Video-fluoroscopy
Barium mealand follow
through
Small bowelstudy
Venogram
%
(n=27)
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Main benefits of performing barium enemas
% n
Increased job satisfaction 66 29
Providing better service for patients 64 28
Increased contact with other staff 45 20
Raised profile of profession 37 16
Increased knowledge and expertise 25 11
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Main drawbacks of performing barium enemas
% n
Radiologist attitude 30 11
Lack of recognition of responsibilities 24 9
Lack of radiography staff 22 8
Lack of time for reporting 19 7
Limitation of further CPD 19 7
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Conclusions
• expectations have been fulfilled
• concerns do exist
• implications for the expansion of the service
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BUT there are obstacles
• reluctance of radiologists to delegate tasks
• increasing shortage of radiographers
• reluctance of radiographers to embrace the use of assistant practitioners
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Experience outside UK
USA
- since 2003 training courses for technologists to
perform BE, intravenous injections etc
- they will be known as radiologist assistants
- do not want to report
New Zealand
- radiographers performing BE
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Conclusions
• radiographers role extension becoming the norm in UK
• number of specialty area increasing
• increasing job satisfaction
• new career pathways for radiographers– Assistant practitioner
– Practitioner
– Advanced practitioner
– Consultant
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Paradigm shift?
Radiographers should provide the utmost service for radiologists
Furby, Radiography, 1944
Radiographers can distinguish between normal and abnormal
Swinburne, Lancet, 1971
Radiographers can report fracture radiographs
Loughran, BJR, 1994
Radiographer performed BE provide an excellent quality examination
with results comparing favourably with published data (for radiologists)
Law et al, Clin Rad, 2002