Standards
The standards are taken from Royal College of Radiology,
Standards of practice and guidance for trauma radiology in the severly injured patients 9.
Fig. 1
100% compliance with all standards.
This is the expectation for all departments whether MTC or TU.
Methods
The RCR sent a survey to all Radiology Departments in the United Kingdom and Northern Ireland in a hospital with an Emergency Department.
The audit was divided into 2 sections:
Section 1 asked about the configuration of radiology department,
number of patients scanned for major trauma and the service configuration for major trauma.
Standards 3 -20 except 11,12,.
This was filled out using a 27 question survey monkey questionnaire.
Section 2 asked questions about reporting times for 30 patients scanned for major trauma from 30 November 2016 going retrospectively.
(Standards 11 and 12)
The questionnaire asked for 4 data points for each patient:
1. Was the CT scan performed in hours (8 am to 6 pm Monday to Friday)?
2. Time to primary survey report if available.
(Time of last image to documented time on primary survey report).
3. Time to final report.
This is the detailed written report provided on RIS/PACS and authorised by a Consultant.
4. In some institutions a Registrar produces the final report with Consultant authorisation/addendum the next working day.
In this scenario the time the final report was first available to clinicians was recorded,
this will be an earlier time than the Consultant authorised report.
Results
85 responses out of 237 (36%) units responded to the survey.
66 (78%) from England,
10 (12%) from Scotland,
5 (6% FROM Northern Ireland) and 4 (5%) from Wales
16 (19%) of responses were from MTCs (9 (11%) adult MTC,
3 (4%),
paediatric MTC,
4 (5%) mixed MTC).
52 (61%) responses from Trauma Units and 17 (20%) other hospital with an emergency department.
In section 2 data was collected for 2161 patients.
450 from MTCs,
1400 from TUs and 311 from emergency depatments without TU status.
In all types of unit the majority of scans were performed out of hours.
784 (36%) of scans were performed in hours 1361 (63%) out of hours and 16 (1%) not documented.
Standard 3: 39 (46%) of departments have an MDCT co-lacated to the ED.
Standard 5: Regarding FAST scanning.
25 (29%) of departments routinely performed FAST scans.
21 (25%) performed FAST scans on an ad hoc basis depending on expertise available.
Of the departments that perform FAST scan 43 (93%) were performed by an ED physician with all the reports being handwritten in the notes.
5 (11%) of departments regularly audit FAST scan results.
Standard 6: 16 departments have MRI available 24/7.
57 (85%) institutions have facilities to transfer to a hospital with an MRI scanner 24/7.
Standard 8: Of the 45 departments answering this question.
29 (64%) have a written protocol for safe transfer of major trauma patient to CT.
Standard 9: Regarding written protocols for CT scanning in the major trauma patient
Table 1
Standard 11: Regarding a primary survey report being issued immediately.
24 (29%) of departments provide a primary survey report in and out of hours,
10 (24%) in hours only and 49 (59%) do not provide a primary survey report.
In total 240 (11%) of 2161 cases had a primary survey report documented.
Of these 240 cases,
time to primary report available to clinicians.
Fig. 2
Standard 12: Regarding time to final consultant radiologist reports.
All institutions has consultants available on call for radiology reporting. 60% of Institutions useNon Trust Consultants (Out Sourcing Tele Radiology Companies) for out of hours reporting.
Times vary from 8 pm – 8am to 11pm -7am.
Time to final consultant report,
1033 (48%) cases were reported within 1 hour,
540 (25%) with 2 hours.
Breakdown of time to consultant report between in and out of hours as percentage of scans performed
Fig. 3
Breakdown of time to consultant report by type of institution as percentage of scans performed
Fig. 4
34 (40%) of departments have registrars first on call for major trauma who report scans out of hours and have a consultant final report the next day.
When this is taken into consideration time to report available to clinicians by institution
Fig. 5
Standard 13: 43 (51%) of trust consultants have teleradiology facilities at home,
although this may be a departmental laptop or a PACs workstation.
Standard 14: 5 (6%) of institutions have IR suite co-located to the ED.
Standard 17: 32 (39%) of institutions have IR on call for major trauma.
All MTCs have IR on call.
Regarding availability of the IR team
Table 2
Standard 19: 67 (100%) of institutions which answered the question have an image exchange portal that transfers images within 2 hours.
Standard 20: 19 (23%) of Radiologists involved in trauma reporting attend a regular major trauma meeting.