In order to attain the appropriate management of radiological examinations and avoid unnecessary medical exposures to patients,
a national project has been carried out within the country,
aiming to implementation of the CIGs in clinical practice.
As a result,
a well-structured five year strategic plan was designed in a multidimensional approach for the implementation of CIGs,
keeping in consideration the local multifaceted barriers,
and a National Clinical Imaging Guidelines Steering Committee established.
1. The National Clinical Imaging Guidelines Steering Committee
The committee has been composed of five respected key opinion leaders in the field of Radiology and Radiation Safety who are motivated volunteering “Champions”.
Their clinical leadership had played a critical role in driving and supporting continuous improvement,
as well as creating an organizational safety culture that supports the guidelines adoption and implementation.
They used the implementation and improvement science,
and changed management strategies and quality improvement (QI) methods.
The national committee members have carried out twice monthly meetings to perform these functions,
as described in Table 1.
2. Adoption and Implementation of the “i Guide” in Egypt
A national professional bodies showed quickly high interest in adopting and implementing iGuide nationwide: the Egyptian Society of Radiology and the Nuclear Medicine ESRNM.
Specifically,
the ESRNM adopted the ESR guidelines “iGuide” without the need for its adaptation.
This decision had returned to several reasons:
· To save unnecessary costs,
efforts and time for developing new guidelines;
· The readiness of Eurosafe to cooperate and support the project with free iGuide standalone portal to instantly support the decision of the end-users at the point of care;
· The sensitization activities undertaken through the project in the form of training events and dedicated sessions on CIGs during ESRNM conferences in 2017-2018;
· The availability and reliability of iGuide and the confidence in its trusted source which is ESR;
· The provision of a recently developed guidelines (2018 iGuide version).
3. Assigning four Centers of Excellence for the implementation of the CIGs in Cairo
Four renowned university hospitals were carefully selected by the project national counterpart to be the Centers of Excellence for the implementation of the CIGs.
They are all based in Cairo and namely: Ain Shams university hospitals,
Cairo university hospitals “Kasr ElAini”,
Armed Forces College of Medicine and Misr University for Science and Technology,
These centers were having strong potential to support the implementation in terms of the presence of motivated Expert Champions keen to endorse the guidelines and improve patient care.
As a proof of their interest and motivation to the project,
the Deans and the key opinion leaders in these four centers approved and supported the implementation of the CIGs.
The availability of a Quality Assurance programme to ensure accuracy and sustainability of the implementation phases,
was another mark of their support to the implementation of the project.
The establishment of the CIGs "AAA" initiative,
which is the Awareness,
Appropriateness and Audit,
was successfully implemented in the four centers.
However,
each center has developed its own mechanism of action according to the experience derived from the Champions’ experience with the internal environment in their facilities and the local feasibilities and constraints.
The major challenges were the defective IT systems in certain areas and the large number of the university hospital staff and patients.
In order to appropriately foster the practical implementation of the CIGs,
the project team decided to develop new educational and training material.
This approach was motivated by the fact that the current available material worldwide was somehow generic and found to leave the audience motivated but confused on what to do in the next step.
In addition,
due to the large number of the staff (radiologists and referrers) in these hospitals,
it has been agreed to move in a step wise approach and conduct each specialty with its specific guidelines and discuss the frequent inappropriate referrals in this specialty.
The implementation phases of the CIGs in the four centers of Excellence include different steps among others:
- The integration of the clinical imaging guidelines in the Education and Training systems for the residents,
medical students and technologists.
Details on the steps undertaken are in (Table 2).
- The conduct of a baseline assessment audit to evaluate the inappropriateness of the CT referrals before the introduction of the iGuide,
as depicted in Table 3.
- Agreeing upon a stepwise approach to start with the emergency radiology,
neuro Radiology and pediatric radiology departments where palpable impact of the CIGs is expected.
- Provision and conduct by Eurosafe of a standalone iGuide access to the end users and WebEx meeting between the NC,
the Egyptian Champions,
the IT team,
Eurosafe and NDSC to discuss how to overcome the IT and implementation challenges.
- Agreeing upon conducting pilot studies to assess the inappropriate examinations.
In January and February 2019,
the first audit has started to assess our methodologies and the preliminary assessemests so far revealed significant reduction in the inappropriate examinations,
however with variable rates and in variable radiological examinations from one center to the other.
After finalization of the first audit, the results will be announced at ECR 2019
* The Egyptian Outreach to Eurosafe,
Arabsafe ,
Afrosafe and the IAEA
Egypt plays a strategic role in the scientific cooperation with the African,
Arab and the European regions,
as geographically,
it is located at the crossroads between the Middle East,
the Mediterranean and Sub-Saharan Africa.
Egypt’s strategic cooperation in the field of Medicine with Eurosafe was essential to attain success for the proactive steps taken towards the implementation of the CIGs.
Meanwhile,
Egypt’s commitment to cooperate and support the African and Arab region is a continuous process via the IAEA’s Technical cooperation programme,
Afrosafe and Arabsafe.