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AHPwSI 6.11.03 Allied Health Professionals with Special Interest. AHPwSI Some experience from Diagnostic Radiography Liz Hunt - Radiology Directorate Manager Addenbrookes NHS Trust Slide 2 AHPwSI 6.11.03 Two examples from Diagnostic Radiography Direct referral from GPs for barium enemas undertaken by Radiographers. Waiting list down from 3 months to 2 weeks Direct GP referral for women with post menopausal bleeding into ultrasound. 200-250 outpatient appointments saved per year Slide 3 AHPwSI 6.11.03 Barium Enema Barium is inserted into the bowel via a rectal tube Air is added to produce double contrast The patient is rotated during the test to ensure all the bowel is visualised Detects cancer, diverticular disease, polyps etc. Slide 4 AHPwSI 6.11.03 Diagnostic Radiographers performing Barium Enemas The Problem Long waiting list for barium enemas 2 week wait for cancer referral to diagnosis Lists only available when Radiologist available SpRs in training must gain competency Consultant Radiologists specialising, and performing more interventional work Slide 5 AHPwSI 6.11.03 The solutions Increase the number of sessions Vet the request forms more thoroughly Decrease the specialist work Train interested Radiographers in GI work and reward them for their skill Slide 6 AHPwSI 6.11.03 The method Radiographer interested in GI work to undergo training Leeds theory course Practical work supervised by GI Consultant 100 barium enemas Exam passed and Trust authorizes Radiographer to perform the examination Reporting done jointly with the Consultant ( latest RCOR guidelines advise joint reporting by all staff ) Slide 7 AHPwSI 6.11.03 Radiographer assigned 2 lists per week If waiting list rises schedule extra lists Second Radiographer undergoes training Back up for each other No list cancellation GP directly refer for barium enemas Waiting list gone down from 3 months to 2 weeks Quality control assessed by audit Slide 8 AHPwSI 6.11.03 Results High patient satisfaction with excellent patient care and reduced waiting list High job satisfaction from Radiographer with specialist skills Recognition as an advanced practitioner in line with the 4 tier structure High satisfaction with GPs who get fast patient diagnosis and can refer on to appropriate specialist for treatment as necessary Slide 9 AHPwSI 6.11.03 Barriers to the process - Before introduction This is a teaching hospital we must enable SpRs to get enough experience How can a non medical member of staff be trained sufficiently to understand this This is the beginning of the end Slide 10 AHPwSI 6.11.03 After introduction There is a positive impact in SpR training in that the Radiographers who have developed great expertise can contribute to training On audit the diagnostic results for the Radiographer are better than those achieved by more junior SpRs Continual audit provides a standard for the service Can John cover my list? Slide 11 AHPwSI 6.11.03 Post menopausal bleeding - Background It is a common gynaecological symptom Women with PMB should be referred to a cancer unit for gynaecological assessment Improving outcomes in gynaecological cancers NHS Executive 1999 Traditionally managed by D+C and hysteroscopy Transvaginal ultrasound can be used as a screen for endometrial cancer in symptomatic postmenopausal women Slide 12 AHPwSI 6.11.03 If the endometrial stripe is uniform and