A national review by the Care Quality Commission (CQC) has found ‘significant variations’ in timescales for the reporting of radiology examinations and a wide range of arrangements to monitor and manage backlogs of unreported images at NHS trusts.
The CQC says that this “could mean a delay to patients’ x-ray results being shared with the clinician responsible for their care, or x-rays being examined by clinicians without specialist training in this area.”
The England-wide report was commissioned following inspections last year which revealed that back-logs of thousands of unreported images had caused ‘significant harm’ to patients.
In response, CQC requested data from all acute trusts in England about the timeliness and governance of radiology reporting.
The CQC report published today, ‘A national review of radiology reporting within the NHS in England’, questions the lack of agreed best practice and calls 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.
Analysis of data submitted by a sample group of 30 trusts show that timescales set for reporting radiological examinations referred from emergency departments vary widely from an hour to two working days. For outpatient referrals, the expected timescales ranged from five to 21 days.
Trusts who are effectively monitoring their own performance had triggers in place to flag-up that a backlog in reporting was starting to develop. CQC’s review found some examples of good practice where routine monitoring minimised delays in reporting. However, it also identified some trusts who had a backlog of images and lengthy waiting times for patients awaiting their results.
The review says that, “With demand for radiology services increasing, the shortage of radiologists is a contributing factor to delays and backlogs in reporting. CQC found the average vacancy rate across all non specialist acute trusts was 14% which supports evidence from the Royal College of Radiologists about the national difficulties in recruiting and retaining radiologists.
“Reporting radiographers can play a valuable role in helping to increase resource, but in some cases CQC found that 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 the review, the CQC has made three recommendations:
1. NHS trust boards should ensure that
- they have effective oversight of radiology backlogs
- risks to patients are fully assessed and managed
- staffing and other resources are used effectively to ensure examinations are reported in an appropriate timeframe
2. The National Imaging Optimisation Delivery Board should advise on national standards for report turnaround times, so that trusts can monitor and benchmark performance.
3. The Royal College of Radiologists and the Society and College of Radiographers should make sure that clear frameworks are developed to support trusts in managing turnaround times safely.
“Members of the Society want to provide the quality of service for all patients that they would be happy to receive themselves, or for members of their family,” said Sue Webb, president of the Society and College of Radiographers.
“The need for timely and consistent reporting standards is a key part of why the Society and College and the RCR established the Imaging Services Accreditation Scheme: to ensure that patients consistently receive high quality radiology services delivered by competent staff working in safe environments,” Sue continued.
“We will continue to work closely with our colleagues within the RCR and with Radiology services around the country to ensure that patients receive the best possible diagnostic imaging service.”
CQC assessment of radiology services was stepped-up last year with inspectors more closely monitoring the reporting of imaging examinations.
Download ‘A national review of radiology reporting within the NHS in England’