Shona S Wilson, Superintendent Radiographer, Crosshouse Hospital, Kilmarnock Meeting the Targets!...

Shona S Wilson, Superintendent Radiographer, Crosshouse Hospital, Kilmarnock

Meeting the Targets!

The Crosshouse Journey


Outline

• Who are we?

• Brief History

• Interim Measures

• Changes in work practice!

• How are we doing?

• The Future – is it bright?


Who are we?• Larger of 2 DGHs• 527 beds (570)• Area Beds:

– Paeds– Gyn– Nephrology– Dermatology– ENT– Maxfac

• 1 MRI scanner – age 7• 1 CT scanner – age 3

• MRI GA service


Introducing the Targets:

• August 2007‘Diagnostic 4 week target will take effect from December 2010 –

there should be additional resources’ (GR)

• In preparation AAHB Radiology - 6 weeks from now!


Brief History

• August 2007:– CT: 5wks; MRI: 9wks

• ~7,000CT; 3,700MRI• 9am – 5pm, Monday – Friday, 9am – 12pm

Saturday (Stroke Service)• (39 hour CT week; 36 hour MRI week)• 4.75 WTE radiographers(6 staff); 2 WTE helpers• 5 departmental porters


Interim Measures

• Capacity and Demand Audit• 111% MRI; 110% CT

• Process Mapping• Forget lunch!• Canvas staff• Voluntary overtime – loyal! • Clear the backload!• Outsource reporting for MRI• Extra session reporting

• (2 qualified Cranial CT Reporting Radiographers still not supported to practice)

• Patients scanned and reported at GJH and CG


The More You do……………….

• January 2009 (16 months down the line)– CT: 8wks; MRI: 9wks

• ~9,600CT (37% ); 4,600MRI (24% ); • 9am – 5pm, Monday – Friday, 9am – 12pm

Saturday (Stroke Service)• Minimum of 5 OT sessions per week

• (47 - 51 hour CT week; 42 - 48 hour MRI week)


It’s not ALL about targets!

• After a year of OT– De-motivated – lack of solutions

– Tired

– Crabbit

– Stress

– Clinical risk

– Recalls

THEN - “4 weeks by March”

NO APPARENT END


SO…….

• Overtime ended till there was a ‘PLAN’

• Waiting lists not maintained


Sustainable solutions -• Ideal Service?• Formalise the 12 hour days

– Rota(s) proposed– Staff involved

• Requirements:– 4 additional WTE staff– 1 additional WTE assistant

• Funding was put in place for the Radiographer posts!


Balance restored!

• 4 posts to advert closing date May

• OT supported again

• 12 hour days commenced October 2009


12 hour shifts!

Mon Tue Wed Thur Frid Sat SUN

Penny 9am - 5pm 9am - 5pm 9am - 5pm 9am - 5pm

Jillian 9am - 5pm

Sandra 9am - 5pm 9am - 5pm 9am - 5pm 9am - 5pm 9am - 5pm

Jacqui 9am - 2pm 9am - 2pm 9am - 2pm 9am - 2pm 9am - 5pm

Fiona 7.45am - 8.15pm 7.45am - 8.15pm 7.45am - 8.15pm

Leigh 7.45am - 8.15pm 7.45am - 8.15pm 7.45am - 8.15pm

John 7.45am - 8.15pm 7.45am - 8.15pm 7.45am - 8.15pm

Marion 7.45am - 8.15pm 7.45am - 8.15pm 7.45am - 8.15pm

Mhari-Clare/Angela 7.45am - 8.15pm 7.45am - 8.15pm 7.45am - 8.15pm

Kim 7.45am - 8.15pm 4.15pm - 8.15pm 7.45am - 8.15pm 8.45am-5.15pm


12 hour shifts!

25th Jan Mon Tue Wed Thur Fri Sat

Joan 8am - 8pm 8am - 8pm 8am - 8pm

Anna 8am - 8pm 8am - 8pm 8am - 8pm

Linda 8am - 8pm 8am - 8pm 8am - 8pm

Mary 9am - 5pm


One year down the line:• 8.8 WTE Radiographers (11 staff)• 3 WTE Assistants (1 still not fully funded)

• 4 Departmental Porters

• CT:• 8am - 8pm Monday – Thursday• 9am – 5pm Friday and Saturday

• MRI:• 8am – 8pm Monday – Friday

(64 hour CT week; 60 hour MRI week)


Benefits of 12 hour days:

CT Waiting Times

6 67

8

65

34

5 54

5 54

3

54 4 4

3 3 3 3

5

8

2

4

6

2 2

4

2

4

12 2 2 2

0123456789

Jan-

07 Feb

Mar

Apr

May

Jun Jul

Aug

Sep

Oct

Nov

Dec

Jan-

08 Feb

Mar

Apr

May

Jun Jul

Aug

Sept Oc

tNo

vDe

cJa

n-09 Fe

bMa

rAp

rMa

yJu

ne July

Aug

Sept Oc

tNo

vDe

cJa

n-10

Feb-

10


Benefits of 12 hour days:MR Waiting times 2007-2010

9

4

6

7.5 78

78

9 9

6

89

11

67 7 7

8

6

8

65

89

8

5 54 4

34

34

7

43

7

0

2

4

6

8

10

12

Jan-

07 Feb

Mar

Apr

May

Jun Ju

lAu

gSe

pOc

tNo

vDe

cJa

n-08 Fe

bMa

rAp

rMa

yJu

n Jul

Aug

Sept Oc

tNo

vDe

cJa

n-09 Fe

bMa

rAp

rMa

yJu

ne July

Aug

Sept Oc

tNo

vDe

cJa

n-10

Feb-

10


Patient Benefits of 12 hour days:

• Reduced waiting times - • Reduced anxiety• Increased flexibility• Increased access• Faster turnaround in Department with still more time

to talk!

• Increased in-patient capacity – no more ‘bed-blocking’!

• Happy patients – even on a Saturday!!


Staff Benefits of 12 hour days• Improved Radiographer involvement

• Improved morale/job satisfaction• Decreased external pressure • Improved development/training opportunities• Great flexibility

• Less pressure on the sessions• Decreased recall rate – no more !

• Happy Radiologists?• No need to be on site!


Service Benefits

• Better utilisation of the equipment • Reliable Service• Improved quality of Service• Improved relations with referrers

“Great service” Itamar Felsenstein


Where we stand now - 6months later (Figures as of 5th March)

• CT:• 10,500 CT (9%); • 9 day wait to appointment• 99.2% completed in target

• MRI:• 5,100 MRI (11%); • 22 day wait to appointment (patient type)• 93% completed in target

5 Departmental Porters– Jan 2008 42% CT exams IP, 13% MRI exams– Jan 2010 47% CT exams IP, 15% MRI exams


However:

• Frustrated Service Development– CT Colonography– GI MRI– Stroke MRI– Cardiac CT/MRI

“CT Coronary Angiography should be developed as a decentralised service” WoS RPG

• Shortage of Permanent Radiologists– 5 WTE Consultants– Total annual throughput 105,500 exams per annum– 2 ‘permanent’ Locum Consultants

(2 qualified Cranial CT Reporting Radiographers still not supported to practice)


Are we there yet?NO!

– MRI– Limited reporting time– Still ‘breachers’– Protocol– Inject/Vet


Acknowledgements:• Clinicians

• Radiologists• Theresa Holliman WLC

But most of all:• My Team

Fiona, Jacqui, Penny, Sandra, Leigh, Mhari-Clare, Angela, Marion, John, Kim and Jillian,

Joan, Linda and Anna

Craig and Eleanor


Any:

Comments?

Questions?

Concerns?

Solutions??

Shona S Wilson, Superintendent Radiographer, Crosshouse Hospital, Kilmarnock Meeting the Targets!...

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