zero wait imaging...patient/clinic/pathway 7 3 4 6 1 ct 180 77 289 69 54 31 2 1 1 704...
TRANSCRIPT
Quality & Reduction in DNA
Zero Wait Imaging &
‘Coupled appointments’
Clinical Team Patient Imaging Team
David J Tipper
DGM Imaging
Quality & Reduction in DNA
Zero Wait Imaging &
‘Coupled appointments’
Clinical Team Patient Imaging Team
DNA reduction to - 0.03%
Increase tariff income by £90,000 +?
Enhance Quality of service - YES
AE IP OP GP
Understand Demand routes
CT MRI US NM Angio X-Ray Mammo FluoroInter
Modality Demand
Speciality Demand
Reporting Activity
Capacity - Diaries
Time
from
Time
to
Appointment
details
Time
from
Time
to
Appointment
details
Time
from
Time
to
Appointment
details
Time
from
Time
to
Appointment
details
Time
from
Time
to
Appointment
details
Time
from
Time
to
Appointment
details
Time
from
Time
to
Appointment
details
MRI 5
Monday Tuesday Wednesday Thursday Friday Saturday Sunday
08:00 08:30 Switch on and prep 08:00 08:30 Switch on and prep 08:30 Switch on and prep08:00 08:30 Switch on and prep 08:00 08:30 Switch on and prep
Small Bowel
08:30
09:15
08:00 08:30 Switch on and prep08:00 08:30 Switch on and prep 08:00
13:15Unsupervised
Non-Contrast
09:15UnSupervised
Gynae (SP)
08:30 13:15Unsupervised
Non-Contrast08:30
10:00Supervised
Gynae (SP)
Small Bowel
10:00 11:30Supervised
Gynae (SP)
10:30Unsupervised
Breast
Small Bowel
12:00 12:45 RECTUM (DC)13:15
11:15 12:00 RECTUM (DC)
11:30 12:15
MRCP
Supervised
Colorectal (RS)13:0009:00
12:15 13:15
13:00
08:30 09:00
13:15 14:00 LUNCH 13:15 14:00 LUNCH
Unsupervised
Contrast
14:00 14:45
Supervised
Gynae/Urology
(GT)
14:00 14:45
17:0014:00
14:00 14:45 Sedated Child
14:45 17:00 Angiogram
14:45 15:30
Supervised
Gynae/Urology
(GT)
14:45 15:30 Breast 2WW
15:30 16:15
Supervised
Gynae/Urology
(GT)
08:30 09:00 MRCP
09:00 09:45Unsupervised
Breast
09:45
14:0013:3013:15 14:00 Breast 2WW
Breast 2WW
16:15 17:00
Supervised
Gynae/Urology
(GT)
16:15 17:00 Breast
Angiogram17:00 16:15 Breast
17:00 20:00Unsupervised
Non-Contrast
14:00Unsupervised
Non-Contrast
17:00 20:00Unsupervised
Non-Contrast
14:45 15:30
17:00 20:00Unsupervised
Non-Contrast17:00 20:00
Unsupervised
Non-Contrast17:00 20:00
Unsupervised
Non-Contrast
20:00 20:15Power down and infect ion
control20:00 20:15
Power down and infect ion
control20:00 20:15
Power down and infect ion
control20:00 20:15
Power down and infect ion
control20:00 20:15
Power down and infect ion
control20:00 20:15
Power down and infect ion
control20:00 20:15
Power down and infect ion
control
13:00 14:00Unsupervised
Non-Contrast13:00 13:00 14:00
Unsupervised
Non-Contrast
09:45 10:30
14:00 14:45 RECTUM (RS)
12:45 13:30 RECTUM (RS)
MRCP
Supervised
Gynae/Urology
(RK)
08:30 09:00 MRCP
09:00 09:45
Supervised
Gynae/Urology
(RK)
08:30 09:00 MRCP
09:00 09:45
Supervised
Gynae/Urology
(RK)
09:45 10:30
Supervised
Gynae/Urology
(RK)
10:30 11:15
Supervised
Gynae/Urology
(RK)
Unsupervised
Contrast13:0011:15
Supervised
Colorectal (RS)13:1510:30
10:30 11:15
Supervised
Gynae/Urology
(RK)
20:00Unsupervised
Non-Contrast14:00 20:00
Unsupervised
Non-Contrast14:00
Daily Checks – 6WW
Modality Description 0>1 1>2 2>3 3>4 4>5 5>6 6>7 7>8 8>9 9>10 10>11 11>12 Grand Total
Angio 1 2 1 6 7 8 2 1 28
Patient/Clinic/Pathway 1 1
Bone Density 59 12 10 7 3 1 92
Patient/Clinic/Pathway 7 3 4 6 1
CT 180 77 289 69 54 31 2 1 1 704
Patient/Clinic/Pathway 1 3 2 9 4 2 2 1 1
Fluoroscopy 5 19 20 8 6 6 64
Patient/Clinic/Pathway 1 4 1
MRI 163 121 287 368 399 187 21 1 2 1549
Patient/Clinic/Pathway 8 4 19 7 13 12 5 1 1
Nuclear Medicine 11 26 12 11 8 7 5 1 3 1 85
Patient/Clinic/Pathway 3 1 4 1 3 1
Radiology 110 35 12 10 10 3 1 181
Patient/Clinic/Pathway 3 3 12 10 10 3 1
Ultrasound 328 221 413 718 682 221 15 1 1 2600
Patient/Clinic/Pathway 2 18 23 32 18 15 13 1
Grand Total 857 513 1044 1197 1169 464 46 4 6 2 0 1 5303Patient/Clinic/Pathway 21 33 63 68 46 34 26 3 4 2 0 1 301
Modality Description6 > 7
Weeks +Total
% Within 6
Weeks
Angio 3 28 89%
Bone Density 0 92 100%
CT 4 704 99%
Fluoroscopy 0 64 100%
MRI 24 1549 98%
Nuclear Medicine 10 85 88%
Radiology 1 181 99%
Ultrasound 17 2600 99%
Grand Total 59 5303 94%
Daily Checks - 2WW
Treatment Function Modality Description 0 1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 19 20 21 22 23 24 25 26 27 28 29 30 31 32 33 34 36 37 Grand Total 2wk +% Within 2
Weeks1wk
% Within 1
Week
CLINICAL HAEMATOLOGY CT 1 1 2 4 0 100% 3 25%
Ultrasound 1 1 0 100% 1 0%
CLINICAL ONCOLOGY (previously CT 1 1 1 1 1 5 1 80% 3 40%
Ultrasound 1 1 1 0% 1 0%
COLORECTAL SURGERY CT 2 1 3 0 100% 0 100%
MRI 1 1 2 0 100% 1 50%
DERMATOLOGY Ultrasound 1 1 0 100% 0 100%
ENT CT 1 1 1 3 1 67% 1 67%
Fluoroscopy 1 1 0 100% 1 0%
MRI 2 1 1 2 6 2 67% 4 33%
Ultrasound 1 2 1 1 1 6 0 100% 3 50%
GASTROENTEROLOGY CT 4 2 1 2 2 3 6 1 1 1 23 3 87% 19 17%
Fluoroscopy 1 1 2 0 100% 1 50%
MRI 1 1 2 1 50% 1 50%
Ultrasound 1 1 2 0 100% 2 0%
GENERAL MEDICINE CT 1 2 4 1 1 1 10 0 100% 7 30%
MRI 1 1 0 100% 1 0%
Ultrasound 1 1 0 100% 0 100%
GENERAL SURGERY CT 3 5 3 1 1 1 2 4 2 1 1 24 2 92% 13 46%
MRI 1 1 1 3 0 100% 1 67%
Nuclear Medicine 1 2 3 2 33% 3 0%
Ultrasound 1 1 7 4 3 2 2 2 1 1 2 26 6 77% 24 8%
GYNAECOLOGY MRI 1 1 1 3 1 67% 1 67%
Ultrasound 1 1 2 0 100% 1 50%
HAEMATOLOGY CT 1 1 0 100% 1 0%
Radiology 1 1 0 100% 1 0%
Ultrasound 1 1 1 0% 1 0%
MAXILLO-FACIAL SURGERY CT 1 1 0 100% 1 0%
MRI 1 1 1 0% 1 0%
Ultrasound 1 1 1 3 1 67% 2 33%
MEDICAL ONCOLOGY CT 2 2 0 100% 2 0%
MRI 1 1 1 0% 1 0%
NEPHROLOGY Ultrasound 1 1 0 100% 1 0%
NEUROLOGY CT 1 1 0 100% 1 0%
MRI 1 1 1 3 2 33% 3 0%
NURSING EPISODE Ultrasound 1 1 1 3 0 100% 3 0%
OBSTETRICS and GYNAECOLOGY CT 2 2 0 100% 0 100%
MRI 2 1 1 4 2 50% 4 0%
Ultrasound 1 1 1 1 1 1 6 3 50% 5 17%
ORAL & MAXILLO FACIAL SURGERY CT 1 1 0 100% 1 0%
MRI 1 1 0 100% 1 0%
Ultrasound 1 1 1 0% 1 0%
PAEDIATRICS CT 1 1 0 100% 0 100%
MRI 1 1 2 2 0% 2 0%
Ultrasound 1 1 1 1 4 2 50% 3 25%
RESPIRATORY MEDICINE CT 1 1 1 3 1 2 9 0 100% 7 22%
MRI 1 1 0 100% 0 100%
Nuclear Medicine 1 1 0 100% 0 100%
Ultrasound 1 1 2 0 100% 1 50%
TRAUMA & ORTHOPAEDICS CT 1 1 0 100% 1 0%
MRI 1 1 0 100% 1 0%
Ultrasound 1 1 2 2 0% 2 0%
UNKNOWN SPECIALTY CT 2 1 1 4 0 100% 2 50%
UROLOGY CT 1 4 2 2 3 1 2 5 12 3 1 36 4 89% 27 25%
MRI 1 2 1 10 1 15 11 27% 15 0%
Nuclear Medicine 1 1 2 1 50% 2 0%
Ultrasound 1 1 1 3 1 2 2 1 2 1 2 1 2 1 2 1 1 1 2 3 31 19 39% 30 3%
Grand Total 1 21 24 1 3 1 15 23 19 10 12 18 23 37 28 2 3 1 2 2 2 4 2 2 1 2 1 7 3 1 1 1 1 2 2 3 281 73 74% 215 23%
No Appointment
No Appointment
Modality Description 0>1 1>2 2>3 3>4 4>5 5>6 Grand Total
Angio 1 2 1 4
Bone Density 5 5
CT 125 13 138
Fluoroscopy 5 1 6
MRI 95 15 110
Nuclear Medicine 19 12 31
Radiology 1 1
Ultrasound 106 19 125
Grand Total 357 62 1 0 0 0 420
Team Ownership
Referral Ratio Analysis
2015/16
Activity
Speciality Description
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Estim
ated
Rat
io
Anaesthetics, Pain & Hypnotherapy 4362 4821 11% 3 1 0 17 0 649 107 0 97 17 0 76 21 989 0.00 0.00 0.00 0.00 0.00 0.15 0.02 0.00 0.02 0.00 0.00 0.02 0.00 0.2
Dept.Clinical Oncology 11554 11939 3% 1 215 217 2800 0 11 23 59 593 1525 0 1189 347 6980 0.00 0.02 0.02 0.24 0.00 0.00 0.00 0.01 0.05 0.13 0.00 0.10 0.03 0.6
Haematology 12639 13410 6% 1 11 51 609 0 9 48 45 107 128 0 555 392 1956 0.00 0.00 0.00 0.05 0.00 0.00 0.00 0.00 0.01 0.01 0.00 0.04 0.03 0.2
Lymphoedema 8845 9028 2% 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.0
Medical Oncology 10029 10420 4% 0 0 0 461 0 0 3 0 32 93 1 159 36 785 0.00 0.00 0.00 0.05 0.00 0.00 0.00 0.00 0.00 0.01 0.00 0.02 0.00 0.1
Palliative Medicine 848 873 3% 0 3 11 103 0 4 7 3 43 69 0 147 208 596 0.00 0.00 0.01 0.12 0.00 0.00 0.01 0.00 0.05 0.08 0.00 0.17 0.25 0.7
ALL CANCER 43915 45670 4% 3 228 279 3973 0 24 80 107 775 1816 1 2049 983 10317 0.00 0.01 0.01 0.09 0.00 0.00 0.00 0.00 0.02 0.04 0.00 0.05 0.02 0.2
Cardiology 10327 10794 5% 165 3 3 508 0 5 20 0 225 781 0 327 61 2099 0.02 0.00 0.00 0.05 0.00 0.00 0.00 0.00 0.02 0.08 0.00 0.03 0.01 0.2
Dermatology 31579 31572 0% 0 3 9 96 0 1 1 4 47 4 0 212 92 469 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.01 0.00 0.0
Diabetic 8877 9261 4% 0 3 0 1 0 0 0 0 3 11 0 21 1 40 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.0
Endocrinology 4657 4605 -1% 33 353 5 261 0 7 17 1 412 504 0 935 588 3117 0.01 0.08 0.00 0.06 0.00 0.00 0.00 0.00 0.09 0.11 0.00 0.20 0.13 0.7
Gastroenterology 9607 11264 17% 0 176 5 1929 241 403 9 3 749 899 0 527 1523 6464 0.00 0.02 0.00 0.20 0.03 0.04 0.00 0.00 0.08 0.09 0.00 0.05 0.16 0.7
General Medicine 2306 0 -100% 17 20 12 1069 0 23 7 11 491 463 0 427 368 2907 0.01 0.01 0.01 0.46 0.00 0.01 0.00 0.00 0.21 0.20 0.00 0.19 0.16 1.3
Hepatology 3872 4485 16% 0 0 0 0 0 0 0 0 0 0 0 0 4 4 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.0
Medicine for Elderly 1830 1998 9% 0 89 4 309 1 4 0 3 151 43 0 299 71 973 0.00 0.05 0.00 0.17 0.00 0.00 0.00 0.00 0.08 0.02 0.00 0.16 0.04 0.5
Nephrology 6316 6299 0% 11 139 0 127 0 240 244 0 28 175 0 440 871 2273 0.00 0.02 0.00 0.02 0.00 0.04 0.04 0.00 0.00 0.03 0.00 0.07 0.14 0.4
Neurology 7725 8195 6% 0 4 1 203 0 12 0 0 2531 195 0 72 35 3052 0.00 0.00 0.00 0.03 0.00 0.00 0.00 0.00 0.33 0.03 0.00 0.01 0.00 0.4
Neurosurgery 618 488 -21% 0 0 0 27 0 1 0 0 308 0 0 9 0 345 0.00 0.00 0.00 0.04 0.00 0.00 0.00 0.00 0.50 0.00 0.00 0.02 0.00 0.6
Osteoporosis 513 1073 109% 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.0
Respiratory Medicine 10586 10380 -2% 0 37 33 2921 0 28 7 17 100 349 0 3011 267 6771 0.00 0.00 0.00 0.28 0.00 0.00 0.00 0.00 0.01 0.03 0.00 0.28 0.03 0.6
Rheumatology 13939 14300 3% 0 664 1 205 0 43 0 0 508 87 0 4333 1084 6925 0.00 0.05 0.00 0.01 0.00 0.00 0.00 0.00 0.04 0.01 0.00 0.31 0.08 0.5
Sleep Studies 27 451 1543% 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.0
Stroke 0 1463 0 0 0 92 0 1 0 0 103 0 0 7 9 212 0.00 0.00 0.00 ###### 0.00 ###### 0.00 0.00 ###### 0.00 0.00 ###### ###### ########
Transient Ischaemic Att 772 810 5% 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.0
Breast Surgery 9946 10565 6% 0 1 0 0 0 0 0 0 1 1 0 1 3 8 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.0
Colorectal Surgery 3257 3745 15% 0 0 0 233 0 13 3 0 56 3 0 28 55 391 0.00 0.00 0.00 0.07 0.00 0.00 0.00 0.00 0.02 0.00 0.00 0.01 0.02 0.1
Ear Nose & Throat 23679 24309 3% 0 0 0 1253 0 336 0 0 1691 71 0 273 815 4439 0.00 0.00 0.00 0.05 0.00 0.01 0.00 0.00 0.07 0.00 0.00 0.01 0.03 0.2
General Surgery 16920 17758 5% 353 81 625 3641 16 676 396 3385 1415 615 0 733 1252 13189 0.02 0.00 0.04 0.22 0.00 0.04 0.02 0.20 0.08 0.04 0.00 0.04 0.07 0.8
General Surgery Grouped 22457 23650 5% 363 81 625 3964 16 691 421 3385 1501 620 0 777 1312 13757 0.02 0.00 0.03 0.18 0.00 0.03 0.02 0.15 0.07 0.03 0.00 0.03 0.06 0.6
Hepatobiliary & Pancreatic Surgery 169 160 -5% 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.0
OMF Surgery 15429 16528 7% 0 0 1 548 0 47 0 0 540 48 0 3283 533 5000 0.00 0.00 0.00 0.04 0.00 0.00 0.00 0.00 0.03 0.00 0.00 0.21 0.03 0.3
Ophthalmology 56515 57999 3% 8 5 1 295 0 11 8 1 283 47 0 196 61 916 0.00 0.00 0.00 0.01 0.00 0.00 0.00 0.00 0.01 0.00 0.00 0.00 0.00 0.0
Orthodontics 13144 13558 3% 0 0 0 41 0 0 0 0 4 5 0 2056 4 2111 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.16 0.00 0.2
Upper GI Surgery 329 335 2% 0 0 0 0 0 1 0 0 3 0 0 4 0 8 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.01 0.00 0.00 0.01 0.00 0.0
Urology 22594 23984 6% 1 89 12 2639 0 131 113 3 961 784 0 3545 4433 12712 0.00 0.00 0.00 0.12 0.00 0.01 0.01 0.00 0.04 0.03 0.00 0.16 0.20 0.6Vascular Surgery 2281 2147 -6% 9 0 0 89 0 1 23 0 31 3 0 16 5 177 0.00 0.00 0.00 0.04 0.00 0.00 0.01 0.00 0.01 0.00 0.00 0.01 0.00 0.1
Paed. Ophthalmology 6820 6847 0% 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.0
Paediatric Cardiology 874 1249 43% 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.0
Paediatric Clinical Haematology 97 99 2% 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.0
Paediatric Dermatology 1668 1786 7% 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.0
Paediatric E.N.T. 4644 4698 1% 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.0Paediatric Epilepsy 443 443 0% 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.0
Paediatric Gastro 107 187 75% 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.0
Paediatric Oral Surg. 884 886 0% 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.0
Paediatric Orthopaedics 6831 6868 1% 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.0
Paediatric Plastic Surgery 246 246 0% 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.0
Paediatric Respiratory Medicine 12 12 0% 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.0
Paediatric Urology 173 173 0% 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.0
Paediatric Surgery 1919 2027 6% 0 0 1 0 0 0 0 0 0 3 0 7 44 55 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.02 0.0
Paediatrics 10331 10744 4% 0 4 3 43 0 59 0 0 347 323 1 788 679 2245 0.00 0.00 0.00 0.00 0.00 0.01 0.00 0.00 0.03 0.03 0.00 0.08 0.07 0.2
Paeds Diabetic Medicine Best Practice 2894 3000 4% 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.0
Anticoagulant Service 277 162 -42% 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.0
Radiology 4658 4665 0% 0 7 1548 28 0 1 1 1433 27 35 0 523 168 3771 0.00 0.00 0.33 0.01 0.00 0.00 0.00 0.31 0.01 0.01 0.00 0.11 0.04 0.8
Hand Surgery 32617 32957 1% 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.0
Orthopaedic 47715 50547 6% 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.0
Orthopaedic Spines 16469 17219 5% 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.0
Hands, Spines & Orthopaedics 96801 100723 4% 3 696 16 1665 0 512 4 9 7876 1277 0 29245 3280 44584 0.00 0.01 0.00 0.02 0.00 0.01 0.00 0.00 0.08 0.01 0.00 0.30 0.03 0.5
Plastic Surgery 3547 3651 3% 0 0 15 59 0 3 0 5 16 0 0 25 49 172 0.00 0.00 0.00 0.02 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.01 0.01 0.0
Total 446517 463989 4% 607 2604 2576 22275 259 3232 1040 4983 19776 8556 3 53468 17359 136736 0.00 0.01 0.01 0.05 0.00 0.01 0.00 0.01 0.04 0.02 0.00 0.12 0.04 0.3
Radiology Demand 1516 FOT Ratios2016/17 Demand
forecast
Activity Plan Bidding
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AFC2 AfC3 AfC2 AFC2 AfC3 AfC4 AfC5 AfC6 AfC7 AfC7 AfC6 AfC7 AfgC8a Cons
CT 124.3 111.4 296.8 0.0 733.0 0.0 0.0 1462.9 0.0 0.0 0.0 0.0 0.0 493.1
Breast Ultrasound 30.1 12.9 0.0 25.2 16.6 0.0 0.0 3.0 7.1 103.7 0.0 0.0 0.0 18.7
Dexa 40.9 27.1 0.0 299.6 0.0 0.0 0.0 299.6 121.3 29.0 0.0 0.0 0.0 0.0
Endoscopy 0.0 0.0 0.5 0.0 0.0 0.0 43.0 0.0 0.0 0.0 42.0 0.0 0.0 0.0
Fluroscopy 8.0 3.4 -63.5 0.0 45.4 4.5 21.2 19.7 0.0 0.0 0.0 0.0 0.0 73.2
Interventional - General 5.1 3.1 17.5 0.0 0.0 0.0 25.3 36.9 0.0 0.0 60.7 0.0 0.0 49.2
Interventional - Vascular 4.9 5.0 31.0 0.0 0.0 0.0 0.0 124.5 0.0 0.0 124.5 0.0 0.0 19.8
MRI 116.9 76.5 29.0 169.5 749.5 0.0 0.0 1819.2 0.0 0.0 0.0 0.0 0.0 284.8
Nuclear Med 59.8 86.2 3.0 0.0 0.0 0.0 0.0 786.9 146.0 0.0 0.0 0.0 82.0 120.8
Mammography 25.8 13.3 0.0 51.6 0.0 0.0 0.0 21.6 20.0 0.0 0.0 0.0 0.0 20.8
Obstetric Ultrasound 1305.8 0.0 0.0 1292.0 0.0 0.0 0.0 0.0 13.3 1292.0 0.0 0.0 0.0 0.0
Plain Film 416.7 418.5 282.7 676.5 0.4 99.0 989.7 1956.2 0.0 0.0 0.0 0.0 0.0 800.8
Ultrasound 377.3 137.1 243.6 1836.1 39.9 0.0 101.0 106.4 8.0 1639.1 0.0 0.0 2.0 240.4
Total Weekday 2515.7 894.5 840.6 4350.5 1584.8 103.5 1180.2 6636.9 315.6 3063.8 227.2 0.0 84.0 2121.4
Total Weekend 0.00 0.00 0.00 377.50 91.00 0.00 137.00 385.00 0.00 1258.20 0.00 0.00 0.00 8.00
Sum WTE 1.29 0.46 0.43 2.42 0.86 0.05 0.68 3.60 0.16 2.22 0.12 0.00 0.04 1.08
Sum WTE with 24% 1.60 0.57 0.53 3.01 1.07 0.07 0.84 4.47 0.20 2.75 0.14 0.00 0.05 1.33
Reporting
ONLY
Ref
eran
ce Modality
Cle
rica
l an
d
Ad
min
Tota
l act
ivit
y m
od
alit
y re
qu
ire
me
nts
Equipment Forecasting
Quality
Transformation Challenge
Quality Driven Sustainable Transformation
• Face to Face Diagnostic & Clinic scheduling for 75,820 out-patients per year in Derby Hospitals who require Diagnostic Imaging
• Impact on 250 - 350 each day across all specialities within the Derby
• Potential for same day Imaging
• Reduction in DNA (Currently 3.5 %)
• Eliminate postal costs
• Potential for place based scheduling
• Avoidance of pathway breach and potential fines
• Potential model for allDiagnostics
Understanding Modality Demand
0
50
100
150
200
250
300
350
400
450
Daily Demand - All Out-Patient
Demand Heat Mapping
‘Coupled Appointments’
Drivers for Change
Drivers for Change
CT
Request
made
Request
Received
- ICE
Request
Received
- Paper
Request
entered
on RIS
Request
Vetted
Appropriate
Request &
RIS coding
Patient
Attends for
scan
Complete
previous
exam & prep
CT Room
Prepare
Injector
Wait or
collect
Patient, ?
Porter
Patient
arrives
Patient ID &
Safety
Check,
information
Transfer
patient onto
CT couch
Check IV,
connect to
Injector if
Required
Arm Injector
Position
Patient in
Scanner
Scout / PilotPlan Axial
Range
Perform
Axial Scan
Check
Patient
Status
In –
Appropriate
Request ?
Transfer
Patient from
CT couch
Check
Images
Transfer
patient to ED
Contact
Radiologist
Prep CT
room and
InjectorType report
on RIS
Written /
verbal
Radiologist
report
Infection
Control
Measures
Complete
Details all
fields on RIS
Dictate
VRVerify report
Verify report
Report
Available
Report
Available
Access
Report
The Imaging Cycle - complex
Patient
Attends
for scan
Green and Red steps
The Trust Pathway Cycle…..
MDT
Drivers for change - QUALITY
Patient centred scheduling for Diagnostics and Follow-ups • Can we build an individualised quality system for all our patients?
• A system that answers the following:-
• How and where do our patients want their diagnostics scheduling
• Supports Clinical pathways and Targets?
• Provide a model to suit all needs of GPs and OPs?
Existing systems
??? DNA??? DNA
Create a Simple Vision
Test 0 DNAFU 0 DNA
Imaging
Coupled Diagnostics/Follow-up Appointments
Individualised diagnostic modelling tailored to meet
patient and pathway requirements
Keep it simple……
Coupled appointments
FU
Reminder Service
7 Days before
** Reminder
Text **
3 Days before
** Reminder
Text **
4 Days before
** Reminder
Call **
Scan Date
& Time
‘Unintended’ consequences
‘Unintended’ consequences of deploying Coupled Appointing • Not limited to Diagnostics
• Significant reduction in DNA across Diagnostics & Primary/Secondary Care
• Optimise resources
• Limited impact on scanner teams
• Maximise tariff
Modality Apr-
16
May-
16
Jun-
16
Q1 Jul-
16
Aug-
16
Sep-
16
Q2 Oct-
16
Nov-
16
Dec-
16
Q3 Jan-
17
Feb-
17
Mar-
17
Q4
MRI 2.9% 3.3% 3.8% 3.3% 3.3% 3.5% 3.7% 3.5% 3.6% 3.6%
CT 1.8% 1.5% 1.7% 1.7% 1.9% 1.8% 1.5% 1.7% 1.6% 1.6%
General Ultrasound 5.1% 5.0% 5.0% 5.1% 5.6% 5.2% 5.1% 5.3% 5.1% 5.1
Obstetric Ultrasound 3.2% 3.2% 2.3% 2.3%
Flouroscopy 3.8% 3.8% 5.8% 5.8%
Nuclear Medicine 1.4% 1.1% 2.2% 1.6% 2.8% 2.9% 1.1% 2.2% 0.9% 0.9%
DEXA 4.7% 2.4% 3.6% 3.9% 3.9%
Plain Film (OP & GP) 0.6% 0.6% 0.8% 0.8%
Total 3.5% 3.4% 3.7% 3.5% 3.9% 3.8% 2.1% 2.8% 2.4% 2.4%
• RTT reduction – Consultant 1 – RTT 42 Days to 24 Days
– Consultant 2 – RTT 36 Days to 22 Days
– RTT Compliance fine avoidance - £480,000
Coupled Diagnostics/Follow-up Appointments
Successes so far – RTT in Ortho, Spinal & Hand
• Significant DNA reduction– 3500+ patients – 3 X DNA - £654
– Potential saving of £94,830 – to date
• Eliminated ‘re-working’ of
patient appointment scheduling– 3445 patients – saved £2914 in AfC2
– Potential saving £10,573
Improve Performance
DNA - Ortho
Period PatientsDNA
Rate
No of
DNA
DNA £
Imaging
£116.00
DNA £
Clinic
£102.00
DNA £
Trust
Pre-Pilot 12500 3.50% 438 £50,808 £44,676 £95,484
Pilot 3445 0.03% 3£348
To date
£306
To date
£654
To date
Patient Query Rate Costs incurred during Pilot (3445 Patients) Year
Patient Query
RateNo of Pts Re-work hours Re-work Weeks Imaging Clinic Annual Cost
Annual Cost
12500 patients
0% 0 0 0.0 £0.00 £0.00 £0.00 £0.00
25% 1114 186 5.0 £1,457 £1,457 £2,914 £10,573
RTT Compliance
Fine avoidance
Month Year
£40,000 £480,000
MDT
Patient Centred Pathway
Request MDT
1 3 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20
Re-Order Prostate Pathway and Coupled Appointments
Day 1 to Day 20 onwards
Clinical Treatment regime to begin MRI >Ultrasound
Biopsy Pathology > Bone Scan >
0
20
40
60
80
100
120
140
Wai
t in
day
s
Combined Prostate Imaging Pathways200 Patients - Sept 15 onwards Review of Urology Patients:
Diagnosis of Prostate C61
Data source -
Open Exeter
Uploaded Data
Q1
2015/16
Q2
2015/16
Q3
2015/16
Q4
2015/16
62 Day Standard
Compliance48.6% 46.5% 59.2% 70.0%
Lost Appointments and £
Coupled Diagnostics/Follow-up Appointments
Derby Figures
ModalityDerby
Demand
NHS DNA Derby DNA Pilot DNA
7.00% £££ 2.80% £££ 0.03% £££
CT 21,020 1471 £104,469 357 £25,371 6 £426
MRI 18,556 1299 £150,675 649 £75,337 6 £696
US 22,579 1581 £67,963 1152 £49,516 7 £280
Nmed 7,204 504 £34,795 65 £4,474 2 £149
Other 6,461 452 £22,614 181 £9,045 2 £97
75,820 3,836 £380,516 2,047 £163,743 16 £1,648
Modality Demand
CT 21,020
MRI 18,556
US 22,579
Nmed 7,204
Other 6,461
75,820
NHS DemandLocal Demand
Flexible and Scalable
Imaging ModalitiesNHS
DNA
Derby
DNA
Pilot
DNA
Modality Total DiD % OPTotal
Benefit7% 2.8% 0.03%
CT 4,306,830 50% 2,153,415 150,739 36,608 646
MRI 2,958,905 70% 2,071,234 144,986 72,493 621
US 8,663,235 50% 4,331,618 303,213 220,913 1,299
Nmed 425,600 70% 297,920 20,854 2,681 89
16,354,570 8,854,186 619,793 309,897 2,656
Coupled Diagnostics/Follow-up Appointments
Potential Scalability – STP and National Impact ??
Clinic Admin Team PatientClinician Imaging Admin team
‘Able to see my patients and
results quickly’
‘I can plan treatment regimes
quicker’
‘Access to Imaging
appointments is much easier’
‘Reduces patient query
phone calls’
‘Eliminates unnecessary
reworking of scheduling’
‘Excellent caring service’
‘I left the clinic with all my information
and dates’
‘My tests and follow-up appointments
were arranged around my needs’
‘Always a positive
experience’
‘Reduction in follow-up
phone calls’
Coupled Diagnostics