Pros and Cons
Pros and Cons
Background. The healthcare system in the U.K. is evolving constantly. There are many factors contributing to this change. Amongst them, the changing demographics, types of diseases, economic factors and political issues, have played a key role in redefining and bringing some key discussions to the fore. The population of U.K. is slated to increase to 70 million by the year 2027. By then, the majority of the population will be over 50 years old. Increased life expectancy will change the demographics in the U.K. and consequently, the pressure on the healthcare system will be enormous. An ageing population will likely suffer from chronic illnesses like Cancer (Beardmore, 2013). Majority of the Cancers are reported in patients above 65 years. This will put a lot of pressure on the way diseases are diagnosed. A proper and quick diagnosis goes a long way in not only, improving patient outcomes, but also, increases life expectancy and decreases healthcare costs.
For the last 40 years or so, radiographers in the U.K. have taken on the additional responsibility of reporting and interpreting images. However, there are experts who argue that the reporting role of the radiographer should be discontinued forthwith. There are many reasons that support this argument. Radiographers per se are not clinicians. They have gained expertise in the technical aspects of the role and are not qualified to be experts to map the clinical journey of a patient. Doctors, who request imaging investigations, do so, to ensure that the resulting report will help in the early diagnosis and treatment of the disease. It does involve a cost and it therefore becomes imperative, that the result be viewed by someone who is qualified and authorised – i.e. a Radiologist. The image report is a formal record of the patient’s history and is a permanent, stored record. It therefore needs to be given a modicum of formality. The radiographer, is not in a position to provide professional clinical guidance and reporting on cases. As we know, only a Radiologist is medically authorised and qualified to study the images and provide a course of action for the patient. The Radiologists undergo close to seven years of training, in order to get qualified. Unfortunately, radiographers and other medical technicians do not have the training in clinical evaluation and formal reporting. In a hospital environment, the roles of all the team members are well defined. Radiographers need to work within those boundaries, to ensure that patient care is given the utmost priority. Since there is no governance or a formal process, radiographer reporting will add more risk in the area of diagnosis and treatment. Patient safety is of utmost importance and decisions must be made by qualified radiologists. The role of the radiographers, though very crucial in the healthcare system, should not transcend its boundaries at the risk of compromising patient safety or patient experience. Radiologists, as long term consultants, are in a better position, to understand patient needs and unique challenges. Radiographers have no exposure to the patient on a long term basis, since their engagement with them is limited to the time spent during investigation. Patients may be suffering from many other co-morbid conditions, which a radiographer may not be aware of. Reporting and drawing inferences, in such cases, may lead to erroneous conclusions and confusion, leading to new challenges in the course of treatments. In the interests of patient health and safety, The National Patient Safety Agency, has opined that there is an urgent need for a formal system of reporting, which is not based on individual strengths or competencies (Nicholson, 2011).
The flip side of this argument is that modern day imaging and reporting plays a crucial role in the diagnosis and management of patients who need long-term care. It is estimated, that over time, the volume of work at imaging departments will increase manifold, burdening an already-stretched system. Add to this, new diseases, modern methods, new technologies that are emerging, and the role of the Radiographer in reporting becomes inevitable. Proper diagnosis and its quick action will help manage patients better and deliver quality health experiences. The numbers of U.K. Radiologists per head of population are fewer compared to other European nations. This presents a big challenge in light of the tremendous pressure that the healthcare system will face in the near future. There is also a shortfall in the number of Radiographers who take up whole-time roles. In fact, according to the Royal College of Radiologists, the U.K had only 4.6 Radiographers per 100,000 people, compared to France with 11.3 (2012). The question then, is of scale and efficient ways to bridge the gap. "New research from the U.K. has revealed radiographer-led immediate (or "hot") reporting in the emergency room can cut overall hospital costs, reduce treatment errors, and improve doctor confidence. Furthermore, if radiographer reporting roles were expanded to chest and abdomen radiographs, where a greater number of interpretive errors are known to occur, the total savings could be substantial.” (AuntMinnieEurope, 2013).
Through the 1990s and into the 2000s, the first-line interpretations were being carried out by the imaging radiographers. The first line reporting really helps in delivering more volume and bridges the gaps in terms of the number of active practicing professionals in the country. Radiographer reporting helps in quick diagnosis, thereby improving patient outcome and reduced cost of healthcare. In their study, Blakeley and Hogg report “The noteworthy improvement in the reporting service is important as the percentage of images reported is one of the key performance indicators that the directorate is measured against, for instance the number of reported examinations more than doubled and the timeliness of report availability had nearly halved” (2009).
Radiographers have been very efficient in reporting on many images like X-Rays and Ultrasound. This has led to many advantages like, less patient waiting time, more time for doctors for other duties, reduced cost of care and from the Radiographers’ point of view, increased value addition and job satisfaction (Smith and Baird, 2007). The reporting responsibility also adds a layer of respectfulness and career progression to the role. Society of Radiologists’ 2006 guidance document on Medical Image Interpretation and Clinical Reporting by Non-Radiologists: The Role of the Radiographer; justifies the role of the radiographer in the reporting process. Once the standards are defined, the radiographers can effectively contribute to the reporting process, enhancing efficiency and taking over the volume of work, in many areas of clinical imaging. The scope of reporting has also increased, from X-ray and mammography to other areas like computed tomography (CT) head scans and certain magnetic resonance imaging (MRI) examinations (Beardmore, 2016). The Society and College of Radiographers suggests that education be imparted during the under graduate programmes in radiography. It is also recommended that the training programmes will need to filter down to the current group of practicing radiographers, if the objectives of efficient radiographer reporting systems are to be met. E-Learning programmes developed with the cooperation of College of Radiographers, is made available to all NHS staff free of cost (Beardmore, 2013). A clear governance framework is absolutely necessary to make sure this system operates efficiently.
Conclusion. Radiographer reporting remains a tenuous issue and needs to be thoroughly analysed, before large-scale implementation can be undertaken.
AuntMinnieEurope., (2013). New guidance emerges on radiographer reporting.
AuntMinnieEurope.com Staff. Retrieved from: http://www.auntminnieeurope.com/index.aspx?sec=ser&sub=def&pag=dis&ItemID=607 738
AuntMinnieEurope., (2013). Radiographer-led 'hot' reporting can help optimize patient care.
AuntMinnieEurope.com Staff. Retrieved from: https://www.auntminnieeurope.com/index.aspx?sec=log&URL=http%3a%2f%2fwww.auntminnieeurope.com%2findex.aspx%3fsec%3dsup%26sub%3dxra%26pag%3ddis%26ItemID%3d607607
Beardmore, C., (2013). Preliminary Clinical Evaluation and Clinical Reporting by
Radiographers: Policy and Practice Guidance. Society of Radiographers. Retrieved from:
Blakeley, C., and Hogg, P., (2009). An evaluation of a radiographer-led
reporting service for Accident and Emergency referrals. RAD Magazine. Retrieved from:
Nicholson, T., (2011). Standards and recommendations for
the reporting and interpretation of imaging investigations by non-radiologist medically
qualified practitioners and teleradiologists. The Royal College of Radiologists. Retrieved
Royal College of Radiologists., (2012). Investing in the Clinical Radiology Workforce – The
Quality and Efficiency Case. Royal College of Radiologists. Retrieved from:
Smith, T., and Baird, M., (2007). Radiographers’ role in radiological reporting: a model to support future demand. Medical Journal of Australia. Retrieved from: https://www.mja.com.au/journal/2007/186/12/radiographers-role-radiological-reporting- model-support-future-demand