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Trusts must improve X-ray reporting, regulator demands

CQC finds wide national variation in reporting timescales and monitoring backlogs of unreported images

Louise Prime

Thursday, 19 July 2018

There is significant variation across England in both the timescales for reporting on radiology examinations and the way in which NHS trusts monitor and report backlogs of unreported images, the Care Quality Commission (CQC) reported this morning. The regulator called on trust boards to ensure they have effective oversight of any backlog of radiology reports, fully assess and manage risks to patients, and use staff and other resources effectively to make sure X-rays are reported “in an appropriate timeframe”.

The CQC undertook its national review after earlier inspections identified serious concerns around radiology reporting in three specific NHS trusts, where inspectors found delays in reporting on radiology examinations, leading to a backlog in reporting; and images that had only been reported on by non-radiology clinicians who were not adequately trained to do so, putting patients at risk.

The review has revealed more widespread problems, and today the CQC has published its report* detailing its concerns about the lack of agreed best practice. The CQC analysed data submitted by a sample group of 30 trusts, which showed enormous variation, from as little as one hour right up to two working days, in the trusts’ own timescales set for reporting radiological examinations referred from emergency departments. It also found that the expected timescales for outpatient referrals ranged from five days to 21 days.

The regulator said trusts that were effectively monitoring their own performance had triggers in place to alert them to the fact that a backlog in reporting was starting to develop, and its review found some examples of good practice where routine monitoring triggered prompt action to minimise delays in reporting. But there were also trusts with a backlog of images, and lengthy waiting times for patients awaiting their results.

The CQC said that the shortage of radiologists (with an average vacancy rate of 14% across trusts) at a time of increasing demand for radiology services is contributing to these delays and reporting backlogs. It found that, in some cases, trusts were not always recognising their skills or allowing protected time for reporting radiographers to report on radiology examinations or undertake relevant training.

As a result of its review, the CQC is calling for the development of national standards for reporting turnaround times, and improved guidance to support trusts in monitoring their own performance in order to protect patients from the potential risk of delayed or missed diagnoses. It said NHS trust boards should ensure that:

  • they have effective oversight of any backlog of radiology reports;
  • risks to patients are fully assessed and managed;
  • and staffing and other resources are used effectively to ensure examinations are reported in an appropriate timeframe.
CQC inspector of hospitals Professor Ted Baker said: “Some patients are waiting far longer than others for their results. We are calling for agreed national standards to ensure consistent, timely reporting of radiological examinations. … and ensure that, for example patients are not put at risk by delays in their X-ray results being reported to the clinician responsible for their care.”

He added: “With demand for radiology services increasing, trusts face real challenges in managing reporting workload. Many rely on outsourcing to external providers or delegating reporting to non-radiology clinical staff within the hospital. Where this is happening, those tasked with interpreting and reporting images must be appropriately trained and competent to do so.

“In the future, new technology has the potential to significantly improve how images can be read and reported. However, we need to act now to address the challenges and help minimise the potential risks so that patient examinations always receive a timely report by an appropriately trained healthcare professional.”

*Radiology review: A national review of radiology reporting within the NHS in England. A report prepared by the Care Quality Commission, July 2018.

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