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Scottish Clinical Imaging Network

The Scottish Clinical Imaging Network (SCIN) is one of four managed diagnostic networks in Scotland and was commissioned approximately three years ago, following on from the work of the Managed Diagnostic Imaging Clinical Network (MDICN), as part of NHS Scotland National Managed Network Service (NMNS).

SCIN is composed of different groups of professionals, employed within imaging in Scotland, who are interested in working together to progress quality issues within their specialty. The network involves radiologists, radiographers and imaging managers. It was established to work across board boundaries, acting as a conduit between the service and Scottish Government or central projects.

A large part of the work of SCIN involves driving up quality and effectiveness across Scotland by sharing good practice. Few radiographers have an understanding of this work and its impact on day to day practice. As strategic decisions always have a “grass roots” effect, this article is aimed at informing radiographers about the work being undertaken by SCIN and to encourage support and participation in this effort.

There is a core team of staff: a Lead clinician (a radiologist), a national Imaging manager (a radiographer) both of whom are seconded for two sessions a week to SCIN. These clinicians are ably supported by a Project Manager and a Project Support Officer who are employed by the National Network Management Service.  This core team focus on progressing the activities of SCIN.

Team produce a quarterly news letter which provides regular updates on work currently being undertaken by the network. SCIN also hosts an annual education meeting which is dedicated to a specific theme each year.

There is a SCIN website www.scin.scot.nhs.uk which presents current and previous network effort

One of the current projects impacting on Radiology is the Radiology Programme within the NHS Scotland Shared Services Health Portfolio.  With the ever increasing pressures on budgets and the increasing demand for public services, the challenges remain for public services to do more with less money.

It is anticipated that sharing of services, including diagnostic imaging, will become the standard way of delivering improved efficiencies and service quality. SCIN is working closely with Shared Services staff to facilitate this project. The most recent addition to this collaborative work is a national approach to Radiographer Reporting working towards the development of a National Reporting Radiographer profile.

Link to the Shared Services: National Radiology Model Strategic Document

Accountability

SCIN, along with other diagnostic networks and clinical networks, is accountable to the Scottish Government Health and Social Care Directorate (SGHSCD) via a complex management structure. (see fig1)

In short, the Government (SGHSCD) set objectives or commission reports to inform future planning. The networks, including SCIN, gather data, explore practice across Health Boards and compile reports that are either delivered directly to the Government (SGHSCD) or more usually via the Diagnostic Steering group which has representatives from SGHSCD

 The SGHSCD Diagnostic Steering Group along with the National Specialist Services Committee (NSSC) provides strategic direction to diagnostic networks that links with national and regional planning structures.

 The National Services Division (NSD) is accountable to SGHSCD via NSSC and commissions work, agrees objectives and funding. NSD also performance manages the network.

Quality dimensions for SCIN objectives

 The Institute of Medicine’s six dimensions of quality are central to NHS Scotland’s approach to systems-based healthcare quality improvement; therefore all SCIN objectives are linked to these six dimensions:

1.    Person-centred: providing care that is responsive to individual personal preferences, needs and values and assuring that patient values guide all clinical decisions

2.    Safe: avoiding injuries to patients from healthcare that is intended to help them

3.    Effective: providing services based on scientific knowledge

4.    Efficient: avoiding waste, including waste of equipment, supplies, ideas, and energy

5.    Equitable: providing care that does not vary in quality because of personal characteristics such as gender, ethnicity, geographic location or socio-economic status

6.    Timely: reducing waits and sometimes harmful delays for both those who receive care and those who give care

The Work of SCIN to Date

7 day working

Access to timely and accurate imaging services is at the heart of modern healthcare delivery for both primary and secondary care. This aids clinicians to make the correct diagnosis and decide the appropriate treatment for patients.

Currently there is variability in access to emergency imaging across Scotland, both diagnostic and interventional, out with normal working hours.

There is increasing patient and clinician expectation that, not only emergency imaging, but a more extended imaging service should be available to them on a 7 day basis from both a safety and person focused point of view.

One of the aims contained in the SCIN work plan for 2014-2015 was to look specifically at the issue of seven day working in Imaging in Scotland, in collaboration with the Scottish Government’s Sustainability & Seven Day Services Taskforce. A subgroup of SCIN was set up in 2014 to look at this issue with the remit to report back to the Task Force on their deliberations.

The group made recommendations on two separate but linked issues with regard to out of hours imaging.

1.    The standardisation of emergency imaging tests and procedures which should be accessible on an equitable basis across Scotland within all acute receiving hospitals

2.    The implementation of 7 day working in Imaging in Scotland.

The document, “Report for the Sustainability & Seven Day Services Taskforce Seven Day Working in Imaging in Scotland” outlines the recommendations of the subgroup.

Link to the report

SCIN plans to audit Imaging services in Scotland against the recommendations in the report.

Interventional Radiology

A SCIN subgroup compiled a discussion document on what a sustainable, resilient, equitable Interventional Radiology Service in Scotland could look like. The document covers the provision of emergency and elective Interventional Radiology Services in Scotland and training issues.

Link to the document will be available soon

PET-CT Group

The SCIN PET-CT group in association with colleagues from the Scottish Health Technologies Group and from NHS England have reviewed the clinical indications for which there is evidence for the effectiveness of PET-CT scanning.

The review has been completed and will be published early 2017.

Further work is on-going looking at national strategic financial planning to sustain PET-CT provision in Scotland.

Primary Care Access to CT scanning

Working collaboratively with primary care colleagues from across Scotland, this SCIN subgroup developed a “Suggested Pathway for Primary Care Direct Access to CT Chest/Abdomen/Pelvis for Patients with Unidentified Suspected Malignancy”. This has been approved by the Diagnostic Steering Group, which is approaching Boards with a view to ensuring implementation of this pathway.

Link to the  Scottish Imaging Pathway for Primary Care Document

National Procuring of Outsourced Imaging

A subgroup of SCIN looked at the issue of the national procurement of outsourced reporting for Scotland to enable imaging services to have easier access to quality outsourced reporting services. SCIN worked collaboratively with National Procurement to develop a national contract to improve quality, accessibility and value for money.

 The national contract for outsourcing companies went live in September 2016

If any further information is required, please contact Ms Kate Henderson, National Commodity Manager- kate.henderson3@nhs.net

Quality Improvement and Standardisation Group

SCIN initially had two subgroups looking at overall quality issues. These two groups have recently amalgamated, as many of the issues arising were identified as fitting in the remit of both groups.

 The following issues are currently being looked at by this merged group.

1.    A national Imaging dashboard, which offers operational management of imaging data, contained within PACS and RIS, is being progressed in collaboration with the Shared Services team

2.    In the meantime, work is being undertaken to optimise the data currently contained with the cost book to enable its display in graphical format for strategic information across Scotland. The format will also aid local service analysis per board. This is national data acquired on a quarterly basis from all the health board.

3.    SCIN are developing a self assessment quality tool with the primary aim of driving up quality standards and with a secondary aim of providing evidence of service quality in comparison with other Scottish Boards.

4.    SCIN supports the concept of Clinical Decision Software and has hosted presentations from interested parties, both vendors and support platform services, at this group.

5.    DNA management and use of Urgency codes have been investigated across Scotland with a draft report being presented to this group. There is an inconsistency of use of these codes across Scotland. The report produced recommendations to support standardisation of their use across Scotland.

6.    Future plans to review vetting arrangements and examination protocols also sit within this group.

Horizon Scanning Group

This SCIN subgroup was established to look at future models for radiology service delivery and workforce issues in imaging in Scotland. The concept of the self assessment tool mentioned above was developed from within this group in addition to the metrics required for data visibility. This is important for service assessment and review.

Current work in this group includes advice on workplace facilities and health in the workplace. Further work in this group will follow on from Scottish Government initiatives and from projects sitting under Scottish Government direction. Sub groups will be formed as and when needed to develop responses to these initiatives.

SCIN is well placed as the pathway between services and government projects such as Shared Services, working in partnership to implement initiatives and joining forces towards providing data supporting the Shared Services agenda. Much of the work already undertaken by SCIN such as quality issues and standardisation of aspects of front line service already supports the Shared Services agenda.

Opportunities

There are many opportunities for radiographers to contribute to the work of SCIN but to date they are an underrepresented group. It is hoped that as the work of the network is more widely known, radiographers of all bands and specialties will play a part in SCIN activities.

Due to workplace constraints, everyone finds it difficult to get time off work for a meeting especially when travel is required. It is therefore likely that much of the quality improvement work will be done via virtual groups, either by e-mail or video/teleconference. This has already been trialled successfully during the development of the DNA- Urgency Code report and in the development of the self assessment tool. Input from all radiographers will be more achievable using this model. Communication via social media is also planned.

In the near future, demand, capacity, workforce and training will be important issues that will affect all staff groups within Radiology departments. Groups will be convened to look at various aspects of work.

SCIN needs your input so please consider getting involved. If interested please contact us nss.scin@nhs.net

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