Patients who do and don’t have bowel cancer are notified much sooner as radiologists at the UK’s University Hospitals of North Midlands transform pathways and innovate with imaging technology.
Patients undergoing CT colonography scans are being quickly notified if they do or do not have bowel cancer, following the implementation of imaging technology that has given staff at University Hospitals of North Midlands NHS Trust the opportunity to redesign pathways.
The trust first went live with its picture archiving and communication system, or PACS, from Sectra in 2017– providing healthcare professionals with much faster access to imaging necessary for making important diagnoses.
Radiologists have found the imaging technology so reliable and easy to use, that it has freed up their time to get the most out of the system.
And this now means that referring clinicians are being consistently notified on the same day as the patient’s CTC scan, also known as a virtual colonoscopy, if their patients test positive for bowel cancer.
Dr Ingrid Britton, consultant gastrointestinal radiologist, at University Hospitals of North Midlands NHS Trust, said: “We can now identify patients with colorectal cancer whilst they are still on the scanner. Previously the radiographer would perform the scan, and then place imaging in a queue to be reported by a radiologist, before the report would be sent onto a multidisciplinary team.
“Now, when radiographers see something during the scan, they alert the imaging team immediately, and using a simultaneous viewing feature in our PACS, radiologists can immediately look at the imaging from their own location and report as the image is generated, before notifying the referring clinician the same day when a patient is positive.
“If a patient knows straight away, they have faith in the service. Getting this right from the beginning gives the patient confidence. This wouldn’t work with a system where the technology doesn’t load quickly enough.”
Patients who show no signs of bowel cancer are also being notified and discharged weeks sooner in a new pilot project at the trust – helping to avoid any unnecessary anxiety for the patient.
Traditionally if a scan doesn’t show signs of cancer, the imaging joins a queue to be reported. Once a radiologist has done the report it is sent to a surgeon’s secretary, who then gives it to the surgeon. The surgeon dictates a letter, which is written by the secretary and eventually sent to the patient.
“That whole loop can take around three to four weeks, or in some cases months, during which time patients are worried they may have cancer,” said Dr Britton. “The 97% of patients we see who don’t have cancer need to know quicker. Our pilot project is changing that. If I know the patient doesn’t have cancer at the point of my report, I now issue a standard letter directly to the patient from our multi-disciplinary team telling them so. We are now discharging patients from scan to report in around 16 days – meaning patients know they don’t have cancer days or even weeks earlier, putting their mind at ease, and saving time as the patient isn’t chasing their GP.”
The developments come as recruitment challenges and continually growing demand are leaving many NHS imaging departments struggling to manage reporting backlogs.
A 2018 report from the Royal College of Radiologists found that 98% of trusts were unable to meet their reporting requirements within radiologists’ contracted hours, and that demand for complex imaging scans such as CT and MRI had increased by 10% per year for the previous five years. And a separate report from the Care Quality Commission found huge variation in reporting delays, calling for local and national action to address the problem and to keep people safe from harm.
The new approaches also come as a new national target for patients to be told whether they have cancer is set to be put in practice by NHS England and NHS Improvement in 2020.
Dr Marius Grima, consultant paediatric radiologist and clinical information officer for children’s, women’s & diagnostics division at University Hospitals of North Midlands NHS Trust, said: “This is about making the most of imaging technology so that we can cope with growing demand, meet national requirements and help to improve care – escalating patients who do have colorectal cancer, and quickly de-escalating those who don’t. Our imaging technology works so well, and is so reliable that we no longer need to think about IT. This means that we have the bandwidth to think about using the system to the full, and to change our pathways to improve the patient’s experience.”
Jane Rendall, managing director for UK and Ireland at Sectra, said: “Ingenuity demonstrated by healthcare professionals at University Hospitals of North Midlands is what technology in the NHS should be about. It’s not about IT. It’s about how people can use it to deliver better patient care, and a better patient experience. I hope other hospitals can replicate this success to spread the same benefits to many more patients.”
