X-ray department

Radiographers work in multidisciplinary teams (MDTs) to image intra-operatively using ionising radiation. The radiographers are responsible according to IR (ME) ER (2000) and IRR (99) regulations for advocating for patient and theatre personnel safety. The Radiographer ensures that the radiation used is safely monitored and the equipment is set-up according to the surgeon’s approach to each case. They need to ensure that important information is recorded after the operation, including that all images have been saved throughout.

The main responsibilities of the department are:

To give the very highest standard of care to the cohort of patients for whom you have been made responsible and to be able to carry out all tasks involved in ensuring that any patient in our care is successfully examined and well cared for;
To act as an independent practitioner, showing the ability to carry out a wide range of diagnostic examinations to a high standard;
To liaise with referral sources where clarification is required for justification of examinations;
To act as a point of advice for imaging referrers; communication with and to other health professionals (in accordance with departmental protocols) and patients are directed accordingly;
To report clinical, non-clinical and radiation incidents in line with Trust and departmental risk management policies.

How do you receive your referrals?

Clinicians with requesting rights (Consultants, Nurses, and other Allied Health Professionals) will request X-rays on the online portal, Clinical Manager. Some referrals are still sent as a hard copy paper referral, but this is time consuming and can lead to duplication. Exemption to online x-ray request will be acceptable when the Clinical Manager system is down and the Downtime forms will be used.

What are the critical steps in the work that your team undertakes?

Perform imaging services for inpatients and outpatients, fluoroscopy for theatre cases as required, portable examinations;

Ensure imaging is performed in line with performance expectations;

Reduce X-ray irradiation;

Report Incidents;

Document and implement new studies related to X-ray;

Change/update X-ray policies and guidelines/Local rules;

Radiation Protection Audits;

Change/update protocols;

Update Statutory & Mandatory training;

Booking and administrative tasks are a part of each radiology team member’s role.

When was this service set up and how has it evolved?

SWLEOC was opened by Her Majesty the Queen in 2004. At the time there was just one small X-ray room that provided service for Inpatients, 4 operating theatres and few Outpatients/POA clinics. X-Ray service was provided Monday-Friday.

Since then, the service expanded to:

Two X-ray rooms, in two different locations;
The X-ray equipment facilities, with new equipment and X-ray rooms, have been updated in line with the latest technology;
The workload has increased significantly over time, and the work pattern for radiographers was changed according to service demands;
Increased Operating theatres workload – the number of operating theatres initially increased from 4 theatres to 5 and in 2021 SWLEOC commissioned a 6th theatre;
Weekends and extended evenings hours allocated to cover X-ray demands including contracted hours shifts on Saturdays and short hours on Sundays.

Which groups does the team interact with and how?

Different stakeholders (face-to-face, by phone, emails);

administration groups/teams (face-to-face, by phone, emails, virtual meetings in Zoom and Teams);

Domestics/Porters (face-to-face, by phone, walkie-talkie);

Other health professionals such as doctors, surgeons, nurses, physiotherapy, pharmacy, intensivists, anaesthetists (face-to-face, phone, emails, virtual meetings in Zoom and Teams);

Management team members (face-to-face, by phone, emails and virtual meetings in Zoom and Teams);

Medical Records, Research and Scheduling representatives (face-to-face, by phone, emails and virtual meetings in Zoom and Teams).

Where does this team undertake its work?

SWLEOC X-ray room;
WOODCOTE X-ray room;
Operating Theatres.

What IT systems does the team use?

SOLITON (Radiology System);
PACS (Picture Archive and Communication System);
IEP (Image Exchange Portal);
Bluespier;
Clinical Manager;
Portal Management;
Microsoft Teams;
Victor Intranet.

What would you want to know if you were asked to establish this service from scratch?

More space allocated for X-Ray department;
Create a new Ultrasound/Dexa room;
Allocate a dedicated MSK Radiologist or Reporting Radiographer for X-ray reporting, especially for emergency

What bottlenecks have your team dealt with?

Clinicians/Referrers using X-ray paper requests result in delays of manually booking and scanning the X-ray forms;

Cancelling/booking Outpatients Clinics or Theatre cases at short notice, sometimes without informing X-Ray department team;

Communication between other departments representative to Radiographers, sometimes communication is ineffective;

National Radiographer shortages;

Cover additional service demand, sometimes at very short notice;

Lack of Study Leave allocation because of the shortage of radiographers.

What steps did you and your team undertake to resolve these problems?

The team regularly reminds Clinicians/Referrers to use Clinical Manager for X-ray requests;

Increase communication/attend morning and hand over meetings with other departmental leads and health professionals;

Gain approval for overseas recruiting;

Collaborate and inform all radiographers vis email for any changes that involve X-ray service ASAP;

For short time courses (1,2,3 days), study leave will be approved as requested;

For long time courses, study leave will be approved for one radiographer at the time.

Are you aware of any historical problems that your predecessors faced before you joined the team?

Lack of new/performant X-ray equipment;

Lack of space for X-ray department;

Ineffective communication;

Frustration/lack of collaboration with other departmental representatives;

Positive feedbacks to X-ray team/Radiographers work recognition;

Support and communications with the administrative teams.

What are the biggest challenges that the person running your team at a new elective centre should be aware of?

Operational changes at very short notice;

Shortage of staff/radiographers;

X-Ray room utilisation/capacity;

New X-ray equipment with Maintenance/Service contract in place.

What are the tips that you would give someone setting up your service at a new elective centre?

Effective communication within organisation teams/stakeholders;

More involvement with Performance Team/regularly meetings;

Dedicated Education/Study/Training area.

Ensure streamlined pathway for x-ray post hip/knee/shoulder replacement to enable same day discharge

What changes have we made that were positive game changers?

Approved recruitment for overseas candidate/radiographer;

Create 2 new X-ray rooms with new X-ray equipment;

Bought 2 new Image Intensifiers for surgical cases in theatre.

Accommodate in Woodcote x-ray room all orthopaedic clinics from EGH Outpatients, Rheumatology, Cardiology and Post insertion of Cardiac stent patients

What changes have we made that created unexpected problems?

Increase X-ray service demand;

Increase Radiographers working hours (overtime);

Weekends X-ray service cover.

Day 0 pathway post-operative patients are not all fit for their X-ray post-op due to lack of motor power and sensation following spinal block, or due to post-operative nausea and vomiting, dizziness and lack of balance. This may place the patient at risk of falls, in which case an Incident Report (Datix) needs to be completed and can cause delay other patients/tasks).

Is there anything special to your service that would be useful for new centres to know about?

Flexible staff and service provision;

Approachable team;

Adaptable to any situation/context;

Professional team members;

Excellent patient care.

Staff

Staff Member: Superintendent Radiographer (Band 7 x 1 WTE plus 4 hrs overtime)

Role:

Working clinically (face-to-face patients) and non-clinically (administrative/managerial tasks), providing supervision/delegation/allocation, communicating with stakeholders and other external clinical/non-clinical representatives;

Lead and manage the department and the radiographers

Investigate incident reports;

Recruitment;

Complete radiographers appraisals and 121 meetings

E-Roster and radiographers rota

Professionally asses the MSK x-ray images as required

Create audits;

Involved in Research projects;

Update IRMER Procedures, departmental Local Rules, Protocols and Guidelines

Staff Member: Senior Radiographer (Band 6 x 4.5 WTE plus 4 hrs overtime)

Role:

Working clinically (face-to-face patients) and administrative tasks, supervise juniors and allocate tasks;

Reporting on performance, offering adhoc data queries and support to the wider team;

Communicate/liaise with other health professionals;

Transfer/Request via IEP x-ray examinations;

Advise and supervise other junior radiographers;

Complete regularly QA tests for x-ray equipment, Reject analysis.

Staff Member: Radiographer (Band 5 x 2 WTE plus 4 hrs overtime)

Role:

Working clinically (face-to-face patients);

Communicate/liaise with other health professionals.