GLOBAL DIAGNOSTICS & ENNIS GENERAL HOSPITAL. An Innvative Outsurcing Slutin fr Ennis General Hspital - Imprved Radilgy Services at Reduced Cst Sinead O Cnnr General Manager, Glbal Diagnstics Ireland September 2011
Executive Summary In April 2011, Ennis General Hspital (EGH) lst the services f their nly full time radilgist and engaged with Glbal Diagnstics Ireland (Glbal) t utsurce the radilgy functin at EGH. The general manager f the hspital used the pprtunity f a departing team member t redesign wrkflws and imprve the services at the hspital. The gals f the new service were Imprved patient access t radilgy services Imprve clinical quality and gvernance Reduce the risk assciated with radilgy services Reduce the cst f the service prvisin Glbal designed a bespke slutin fr EGH invlving a new RIS PACS infrastructure, digital wrkflws, remte and n-site radilgist supprt alng with prgramme supprt Since engagement with Glbal Diagnstics 28,000 patients have been seen and all backlgs at the hspital dealt with Average time between examinatin and reprt has fallen frm 9 days t 10 hurs Average time between examinatin and reprt fr all A&E cases has fallen frm 20 days t 45 minutes. Urgent cases are reprted within 15 minutes The cst f running the radilgy department has fallen by 29% whilst the hurs f cnsultant radilgist supprt has mre than dubled (45 t 96 hurs) The cst per hur f cnsultant radilgist time has fallen frm 192 t 64 frm the ld structure t the service prvided by Glbal Glbal has intrduced clinical audit, quality assurance and clinical gvernance structures, including external peer review, multidisciplinary team (MDT) meetings, discrepancy meetings etc. The implementatin f the EGH and Glbal slutin has nt been withut challenges. The challenges range frm thse f a technical nature, t thse f a cultural resistance t change. The Glbal slutin prpsed and implemented fr radilgy services in Ennis has prven that achievement f best in class service and the achievement f significant cst efficiencies are nt mutually exclusive. The Glbal Diagnstics slutin can be implemented in ther hspital lcatins acrss the cuntry and it can drive a material reductin in cst while allwing fr the delivery f patient services t a level f quality that culd and shuld be the hallmark f a 21 st century public health service. Benefits and Service Imprvements Realised 1. Imprved patient and referring dctr service. Since the intrductin f the service in April 2011, the EGH radilgy reprting service is n lnger a bttleneck in the hspital. Hspital dctrs and GPs receive all their results within 24 hurs and can nw effectively manage their patients in the timeline expected and required. Radilgists are available t reprt n studies at all times frm 8am thrugh 10pm seven days per week. The hspital GM recently received a nte f appreciatin frm ne f the lcal GPs which said that the new service is simply Excellent. 2. Imprved Clinical Quality, Gvernance and Risk Management Reprt Turnarund Times: Pre the arrival f Glbal Diagnstics in Ennis the average reprt turnarund time fr a radilgy reprt was 9 days. The grid belw shws the average Glbal reprting turnarund times in hurs since the pilt started. The initial bjective was t achieve a 1
N. f Patients Hurs reprt turnarund time f 48 hurs. This bjective was achieved in the first mnth and as the chart clearly illustrates dramatic imprvements have been achieved since then and this metric cntinues t be a fcus fr the Glbal team. Average Time frm Examinatin t Reprt return at Ennis pst G-Live f Glbal service 45 40 35 30 25 20 Hurs 15 10 5 0 Apr-11 May-11 Jun-11 Jul-11 Aug-11 A cmparative study f the reprt turnarund times between the first 560 patients in Sept 2010 (pre Glbal service prvisin) and the same number in Sept 2011(pst Glbal service intrductin) shwed the fllwing significant changes year ver year. Average Time frm Examinatin t Reprt: September 2010 (Old System) Vs September 2011 (Glbal) 600 500 400 300 200 Old System Glbal 100 0 Same Day Next Day 2-3 4-6 7-10 11-15 16-20 21-29 Time Line (days) In additin t the significantly imprved reprt turnarund times, LEC cases are reprted within 3 hurs and EGH physicians have the ptin t priritise a patient as critical which will ensure the study is read within 15 minutes f the examinatin being cmpleted. Cnsistent reprt turnarund times allw hspital dctrs and GPs t cme t expect and rely n utilising the radilgy reprt in a practive manner when dealing with a patient s management. This had nt previusly been the case in EGH. 2
Cnsistent Delivery f Services: The new prcess in radilgy arund prtclling CTs and lcal physician supprt fr IV cntrast ensures that the CT service is cnsistently available and n lnger cancelled when the lcal radilgist is absent. There is significant capacity t grw this service if a full time radigrapher was allcated t this rle. Radilgist access r reprting capacity is n lnger a limiting factr. Discrepancy Meetings- In accrdance with the Irish Cllege f Radilgy Guidelines, Glbal Diagnstics hlds a discrepancy meeting six times per annum (The Faculty f Radilgy, 2011). Cases fr discussin can be submitted by the hspital, by a member f the lcal team, by a clinical lead and r by any f the radilgists. Cases can als arise frm the cmplaint management prcess. Outcmes f the discrepancy meeting are shared with the hspital. MDT Meetings Mnthly MDT meeting are held n the last Tuesday every mnth with medical teams submitting cases fr discussin (The Faculty f Radilgy, 2011). This Radilgy MDT meeting is a first fr EGH. The meeting are well attended and supprted by hspital cnsultants and their teams. 3. Clinical Audit The reprt f the Cmmissin(2008) n Patient Safety and Quality Assurance Building a Culture f Patient Safety recgnised the imprtance f Clinical Audit(Health, 2008). The reprt states Clinical Audit arguably cnstitutes the single mst imprtant methd which any healthcare rganisatin can use t understand and ensure the quality f the service it prvides. Clinical audit is nw an integral part f the EGH radilgy department and is carried ut in line with the Requirements fr Clinical Audit in Medical Radilgical Practices (HSE, 2011). All audit results are shared with the hspital management team and ther relevant parties. 4. Service Cst When a hspital mves frm a film based envirnment t a RIS PACS-led digital envirnment many things are impacted, nt the least f which is the cst f prvisin f the service. The intrductin f a RIS PACS slutin and the teleradilgy reprting slutin resulted in a significantly different wrkflws within the radilgy department. The department achieved an verall saving f 29% in year ne f its intrductin and this was achieved while increasing access t radilgists and reprting frm 40 hurs t 96 hurs. Key Learnings and Next Steps There is significant pprtunity within the HSE t utilise this slutin in ther hspitals. It is never envisaged that teleradilgy wuld be cnsidered a single slutin fr all hspitals but rather that it s apprpriate deplyment can have wide ranging benefits. Small reginal hspitals the cre benefits highlighted in this dcument can greatly assist smaller reginal hspitals, sme f which are nt even n the NIMIS rll ut. These hspitals ften d nt have the capacity t attract full time radilgist supprt r d nt have the capacity t invest in the infrastructure required. The slutins presented here wuld be particularly relevant t Minr Injury Units which perate 14 hurs a day but will nt have radilgist supprt fr all f this time. Larger urban hspitals there will always be a requirement fr n-site radilgist supprt at majr hspitals but as has been seen in recent years, even the majr centres struggle t manage the imaging wrklad that is created. It is clear frm the evidence presented in this paper that verspill wrklad that cannt be addressed by the lcal radilgists culd be delivered by an external clinical prvider like Glbal Diagnstics. This is far cheaper fr the public health service, desn t invlve the uncertainty that ges with lcum staff and can be managed n a variable cst basis. The new wrk practices have generated savings fr the hspital, have prvided referring physicians inside and 3
utside the hspital with imprved services but mst f all have benefitted the patients wh use Ennis General Hspital n a daily basis. 4