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.

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

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

Radiology

- serious shortage of radiologists- increasing waiting lists for procedures- year on year increase of examinations performed

- additional demands on radiologist’s time

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

www.sor.org

www.rcr.ac.uk

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

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

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)

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

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

Results

71% response rate

(n=48/68)

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

Motivation

0

10

20

30

40

50

60

70

80

90

100

Increased jobsatisfaction

New challenge Increased personalautonomy

Increased patientcontact

%

% of total BE performed by radiographers in their department

% n

more than 80% 47 21

50% - 80% 33 15

less than 50% 20 9

Reporting

• 16% (n= 7) reported own enemas without input from radiologists

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)

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

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

Conclusions

• expectations have been fulfilled

• concerns do exist

• implications for the expansion of the service

BUT there are obstacles

• reluctance of radiologists to delegate tasks

• increasing shortage of radiographers

• reluctance of radiographers to embrace the use of assistant practitioners

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

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

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