Critical Incident Related to Interprofessional Delivery of Health and Social Care - Essay Example

A Critical Incident Related to Interprofessional Delivery of Health and/or Social Care Introduction This assignment analyses an incident that impact the practice of this writer in a great way. In this assignment, the background of this incident, implications, analyses, and relevance to the practice as a radiographer in the NHS will be dealt with. The practice of a radiographer in the National Health Service has many issues and problems; however, the incident which is going to be described and analyzed, in this author's opinion will have many significant implications and possible changes in the current radiography practice framework used in the NHS. Incident It was therefore visualized that the National Health Service (NHS), in order to provide quality services to the patients would need information technology. Therefore, they set up The National Programme for IT in the NHS ("the Programme" or NPfIT). This system obviously puts patients at the centre of decision making through innovations in information and communication technology. This is an ambitious plan which is built up on the premise that it would be able to create an environment where it would be possible to share information across a national network that would be secure, fast, and designed to support efficient and quality clinical care delivery. This system is designed to replace local NHS computer systems with more modern integrated systems. The key elements of the medical record will be available throughout the NHS. Each NHS care record will be formed from information held in a number of regions, which would automatically be brought together when accessed by authorized persons. The confidentiality issues would be ensured strictly, and professionals will have different views of the record based on their roles in patient care. That which is relevant to radiography is apart from important demographic data, electronic prescriptions, and emails; it will use PACS to archive radiographic images. This would facilitate communication between different professionals involved in the care of a patient including the radiologists. It has already been observed that the diagnostic waiting time has been reduced dramatically by the availability of this new IT system, since it uses PACS replacing the file-based x-rays with digital imaging which is immediately and remotely available at any time of the day or night. The reduction in waiting time has been really dramatic in the sense that the time needed for diagnosis has been reduced from six days to few hours. There is indication that there is efficiency saving from release of storage space, film, chemicals, and stationery. On an annual basis, the savings in an NHS trust is in the range of 296,000. The main significance, however, lies somewhere else. As has been mentioned effective patient-centred quality radiology care needs information to be disseminated, particularly in radiologic practice. Moreover, the clinical information in greater detail can be accessed by the radiologists. The central summary record can be updated, and the in-built communication system can be utilized to collaborate between the professionals (Department of Health, 2007). PEST Analyses To examine whether these changes are actually suitable for the practice of radiography, it is important to undertake a PEST analysis where the political, economic, social, and technological issues related to this change would really benefit the profession of radiology and people as it has been declared in its description. It is, however, accepted that a programme of such magnitude across the nation must have some problems in implementation, but a PEST analysis would be able to demonstrate the rationale of such a programme. In this author's view this is a positive incident in that it would facilitate resolution of many problems that the profession of Radiology and Radiography is currently going through. Political It is very evident that these changes have been implemented and will be implemented by political decisions and legislations. The very fact that the NHS is implementing IT in care delivery is a political phenomenon. The current complaint against the radiologists and radiographers are that they hardly participate in any healthcare related decision making. Moreover, their lack of communication, delay in reporting, and errors have contributed to the considerably delay in getting an imaging investigation done. As per reports of Healthcare Commission, 2007, in many trusts the waiting time are way above the target waiting time of 18 weeks, and in some cases the wait is up to 1 year. This defeats the purpose of a healthcare system, and hence invites political intervention (Healthcare Commission 2007a). Diagnostic delays often delay the referral process from one consultation to another. In response to the customer dissatisfaction, the government therefore came up with a policy response where the main goal was of increasing the availability of, and improving access to, diagnostic services with increment of level of technical support to the trusts. It was expected that such a system would reduce the workload of the radiologists and radiographers, and a system reform management could solve the rest of the problems (Harrison and Appleby, 2005). Shift of location in order to reduce the work load would be enabled by the ability of data access including images from archives from anywhere within the NHS, and this would reduce the workload on the radiologists leading to reduced waiting time. As expected the matter of significant political importance is that, rapid imaging, reporting, and communication system is NPfIT through improvement in care delivery would transform the patient experiences, and they can have more empowerment in the sense that they will be able to view their own clinical record through Healthspace, a web based portal that will help to provide increased patient satisfaction, greater confidence in the NHS, a reduction in anxiety, greater understanding of personal needs, better relationships with professionals and positive health effects. Politically, these are significant parameters for support of any government by the population. Incorporation of decision support software will help the practitioners in delivering improved and standard screening, diagnosis, and treatment. Moreover, there would be fewer incidences of lost records and report that would be legally advantageous for the government (Department of Health, 2007). Economic This specific advance is of demonstrable economic implications. It is easily conceivable that implementation of such a project is associated with huge cost. The estimated cost for this project thus far is the largest IT-related cost in the world. That which is relevant to radiology and radiography is very profitable in the sense that this would be a filmless technology that is digital and streamlined, lower cost, and available in the physician friendly workstations. With the advent of flat-surface digital detectors, even the bedside radiography would be directly digital. The PACS has been demonstrated to be a user-friendly, cost-effective picture archiving and communication system, where there is a possibility that the cost of uncertainty element in the radiographic diagnosis can be overcome by the facility to view all studies of a specific patient that had been archived digitally (Margulis, 1981). There would be a scope for building the virtual reality of the patient pathology by reformatting the previous data. Moreover, development in the IT field is causing a fast decrease in the cost of data transmission and data computing. This would open the scopes of remote computing when medical records are available from a distance within this system. This would also save time and revenue. Most importantly, this can serve as an interprofessional practice tool with no cost through exchange of information with the referring physician (Margulis and Sunshine, 2000). Economically, the savings that PACS connected to a network may provide can be really enormous in the financially constrained healthcare area. Apart from the cost savings in direct digital filmless imaging in cost of radiographic films, in stationery, and in reagents and space, the economic significance of accurate diagnosis resulting in effective therapy should not be ignored (Reiner et al., 2005). The appropriate higher cost imaging study that leads to precise diagnosis when performed first is generally cost saving. Lastly, NHS litigation authority pays 500 million per annum on an uncontested basis because records cannot be produced (Department of Health, 2007). NHS ends up paying a huge amount of money in claims and litigations just due to the fact that film reports are often lost, and the amount of money that this IT system can save could thus, in effect, be enormous. Social The social context takes a different view. The accelerated progress of diagnostic imaging technology through such systems will demand increasing allocation of resources, and that is currently the central focus of the policy makers. This would lead to a marked rise in the healthcare costs, and it is often an idea of the population that the medical imaging professionals are purveyors of costly and sophisticated technology. As a result cost-restricting regulations are a must. It is known that 50 to 70% of radiologic investigations are routine, and if they can be done digitally, all the objectives of such a programme will be served. It would be advantageous for the radiologists to use this technology in the outpatient setting. Once cannot obviate the high costs associated with a digital imaging system, but as highlighted earlier, the overall savings to healthcare delivery might make this form cost effective (Stiles and Belt, 1991). It is important to envisage that such a smooth system will have impact on the society, and the expectations of the population will increase in comparison. Those who are habituated to tolerate waiting, miscommunication, delay, and pains of disease would behave otherwise once such programmes are implemented. The radiologists would increasingly be regarded as active participants in the care processes, and they cannot ignore liabilities. They would have to face increased patient advocacy, economic accountability, and regulatory intrusion. The improvement in technology in the healthcare field will continue to create opportunities in diagnosis and treatment of an unprecedented nature and will increase radiology's exposure to society's demands. The radiographer who would be equipped with new instruments and capabilities must be ever mindful to apply these in the broad societal context so the unique potential of such a system is realized (Sheehan, 2008). Technical Currently, every week, two Picture Archiving & Communications Systems going live almost every week with presently 157 million digital images stored and every week, 5.3 million images are being added to this system, and it is undertaking around 800,000 patient studies per day. Technologically, this is a better system to capture and report findings at a faster rate, with the advantage of interpretations with communications with the referring physicians. Although it has been argued that the reporting is slower than the conventional methods, it is to be accepted that it has the advantage of quick archiving and consultation online. Despite these arguments, it can have casetteless radiography and benefits of simulation to predict future images without exposure to radiation (Bryan et al., 1998). Applied to the general radiology, where most of the imaging studies are done, the cost implications with even a prolonged time of reading may be substantially favourable. Since technologically, the historical images will be easier to access and should be more readily available, and the system may suggest a diagnostic aid and voice software may help recording of the report, it is expected that with the familiarity can effect a positive change in the reporting practices of the radiologists and the radiographers. The Picture Archiving & Communications Systems' Business Case shows 1 billion net benefit, both cash and non-cash, to the NHS over 10 years since it can save 100,000 staff hours equivalent to 50 staff for any single medium hospital. It has been technologically suited to enable earlier diagnosis and more prompt treatment with provision of digital transfers, thereby easing the clinical decision making (Department of Health, 2007). Earlier many clinical decision making meetings would have been postponed due to nonavailability of reports, and lost x-ray films would cause cancellation of 5000 patient procedures per hour. In summary, digital detectors would allow implementation of digital picture archiving and communication system. In this system, images are stored digitally and are available anytime. Image distribution in hospitals can now be achieved electronically through web-based technology with absolutely no chance of losing images. Other technical advantages include "higher patient throughput, increased dose efficiency, and the greater dynamic range of digital detectors with possible reduction of radiation exposure to the patient" (Korner et al., 2007). Conclusion In Europe, particularly in the UK, an increasing onus is currently being placed on the radiologists or radiographers to ascertain reports are communicated effectively to the referring clinician, specially when an urgent, unexpected, critical, or doubtful diagnosis is made. The 2004, Manual of Cancer Measures published by the DOH in England determines that delayed or ineffective communication is a major cause of care delivery of reduced quality (Department of Health, 2004), and growing patient dissatisfaction leads to legal rulings of political importance and legislations that radiologists and radiographers have responsibility to communicate. The failure to communicate hence is one of the major allegations against the radiologists and radiographers which mainly encompass failure to highlight or draw notice of the referring clinician to urgent, unexpected, or doubtful diagnosis. The European Association of Radiology acknowledges legitimately that failure of effective communication is a matter of significant import for radiological errors. This envisages a need for a robust system of clinical communication over and above the normal reporting mechanism that the radiologists and radiographers follow (European Association of Radiologists, 2005). This would ensure that a new or unsuspected diagnosis following radiological investigation would be highlighted without delay to referring clinician, which can construe an important risk reduction strategy in clinical practice. The European Association of Radiology emphasise despite acknowledgement of its necessity that direct communication and direct contact between the clinicians in the busy hospital environment may be time-consuming (Royal College of Radiologists, 2004). It has been agreed that although it is the clinician's responsibility to read and act on the report issued, the radiologists are also partners and collaborators in care so they need to issue a timely report through a robust auditable system for communications (Garvey and Connolly, 2006). Problems Interprofessional collaboration by any means has many perceived benefits. There are many cases, where the radiologist cannot pinpoint a diagnosis, and discussion with the clinicians may reveal important bits of history of the patient suggesting an implication of any particular radiological finding. It is always pragmatic to open communication with the referring physicians since that can narrow the diagnostic possibility and hasten care. Moreover any unsuspected finding and its awareness may alter the course of care and actually favour the patient outcome. Sophisticated IT systems including Picture Archiving Communication Systems (PACS) can highlight urgent reports and receipts can be acknowledged electronically to enhance patient care, and clerks would only be necessary to make phone calls to ensure that the report has been read. The issue of work-load of the radiologists and the radiographers has been often incriminated in failure of timely delivery of reports and failure in establishing a professional communication. Inadequate facilities and backdated time-consuming systems lead to a huge waiting time for the patients. It is astonishing to note that many people even now need to wait for a period of somewhere between 26 months to 1 year for getting an imaging study done when the national target is just 18 weeks for both inpatients and outpatients. It appears that the achievement of 18-week target waiting time is a major challenge. The Operating Framework of 2007-2008 suggests, "Genuine clinical engagement, the development of new alternatives to existing services and the effective use of information management and technology will be the key to successfully delivering the 18 week objective" (Department of Health, 2007h). This reflects the findings from the Quality Audit in Radiology. For an effective delivery of care in Radiology, the radiologists and radiographers need to manage the services provided to the clients. Since Radiology as a discipline is growing at an astronomical rate and the modes and processes of investigations are changing with progressively increased use of high technology, it is felt that things need to change in the service with the target being providing a better quality service. The recommendations, consequently, have been to develop standards of service and systems in such a manner that the system can generate accurate reports with no waiting time, that is, hot reporting following the radiographic examination (Prime, 1996). While doing this, however, it is important to remember that lack of communication between radiologists and radiographers and the referring clinicians may be misinterpreted without conforming to the actual pathologic condition that the patient is suffering from. The ability of radiologists and radiographers to synthesize a workable and coherent report is a variant of the extent of communication between these two parties, since there is always a degree of uncertainty in many cases. It is accepted by all, and the need for an interprofessional collaboration arises here. If this uncertainty is discussed with the clinician, this discussion often narrows down the pathological possibilities of a diagnosis. The need for verbal communication or otherwise with the image in the forefront thus becomes a necessity (Patterson and Sponaugle, 2005). The other recommendation is to become more efficient, and this would occur in two areas, namely, improvement in performance indicators and efficient information management. The information management system is inefficient currently leading to incomprehensible summary information. The existing Radiology Information System (RIS) is efficient in managing the internal workflow of a radiology department, and there is a lack of system that can collaborate interprofessionally, and that is the need of the hour (Prime, 1996). Although RIS can tag links to the Patient Administration System, this can just manage the billing and incorporation of summaries in the patient record system and can maximally schedule appointments. However, when sharing data to interpret and apply in patient care, it becomes impossible to use the existing system, and it hardly is able to reduce the workload, thus leading to no change in the turn-around-time or wait time. In the coming years, Radiology as a discipline will experience constant growth of high technology through use of better and innovative imaging systems and use of information technology in report sharing. This could provide e-mail links to general practitioners, ward ordering through hospital-wide information network, linking of RIS to PAS, acquisition of images through pure digital means, and sharing of images across picture archiving and communication systems. In this manner Radiology and Radiography can be an IT rich area which could change the present scenario if implemented (Audit Commission, 1995b). Reference List Audit Commission (1995b). For your information - A Study of Information Management and Systems in the Acute Hospital HMSO, London Bryan, S. et al., (1998). Radiology Report Times: Impact of Picture Archiving and Communication Systems. AJR; 170: 1153-1159 Department of Health, (2004). Manual of Cancer Measures-1E-205 rapid notification of an unsuspected imaging diagnosis of cancer. London, UK: Department of Health, 2004. Department of Health (2007h). The NHS in England: Operating framework for 2007-08. London: Department of Health. Available at: www.dh.gov.uk/en/Publicationsandstatistics/Publications/PublicationsPolicyAndGuidance/DH_063267 (accessed on November 9, 2008). Department of Health, (2007). The National Programme for IT in the NHS. Authority of the House of Commons London: The Stationery Office Limited. European Association of Radiologists. Good practice guide for European radiologists. http://www.ear-nline.org/index.php pid=93 (accessed Nov 9, 2000). Garvey, CJ. and Connolly, S., (2006). Radiology reporting-where does the radiologist's duty end Lancet 2006; 367: 443-45. Harrison A, Appleby J (2005). The War on Waiting for Hospital Treatment: What has Labour achieved and what challenges remain London: King's Fund. Harrison, A. and Thorlby, R., (2007). 18-week waiting times target - an update. Available at http://www.kingsfund.org.uk/publications/briefings/18week_waiting.html downloaded on November 9, 2008. Healthcare Commission (2007a). An Improving Picture Imaging services in acute and specialist trusts. London: Healthcare Commission. Available at:www.healthcarecommission.org.uk/_db/_documents/Imaging_AHP_report_tag.pdf (accessed on 9 November, 2008). Korner, M., Weber, CH., Wirth, S., Pfeifer, K., Reiser, MF., Treitl, M., (2007). Advances in Digital Radiography: Physical Principles and System Overview. RadioGraphics 2007; 27:675-686. Margulis, AR., (1981). Whitehouse lecture. Radiologic imaging: changing costs, greater benefits. Am. J. Roentgenol.; 136: 657 - 665. Margulis, AR. and Sunshine, JH., (2000). Radiology at the Turn of the Millennium. Radiology; 214: 15. Prime, N.J., (1996). Audit in radiology. Health Informatics Journal, 1996; 2; 35 Patterson, HS. and Sponaugle, DN., (2005). Is infiltrate a useful term in the interpretation of chest radiographs Physician survey results. Radiology;235(1):5-8. Reiner, BI., Salkever, D., Siegel, EL., Hooper, FJ., Siddiqui, KM., Musk, A., (2005). Multi-institutional Analysis of Computed and Direct Radiography Part II. Economic Analysis. Radiology; 236:420-426 Royal College of Radiologists (2004). Teleradiology-a guidance document for clinical radiologists. London, UK: Royal College of Radiologists, 2004. Sheehan, M., (2008). Ethics and policy: dealing with public attitudes. Radiat Prot Dosimetry; 129: 295 - 298. Stiles, RG and Belt, HC., (1991). Socioeconomic and political issues in radiology: a historical analysis. Radiology; 180: 823. Read More