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Effectiveness of UK radiographer image reading.

Article Excerpt
Inner-city hospitals throughout the United Kingdom have reported radiologist shortages. (1,2) At 1 hospital, the shortage resulted in radiology staff giving low priority to formal reporting of emergency department radiographic images (although emergency department staff routinely examined all medical images). Consequently, these images were not reported by radiologists in a timely fashion, and some went unreported. A radiographer image-reading service was introduced to resolve this problem. The radiographers were trained and educated in image reading, and their total clinical time commitment to this activity was 1.5 full-time equivalent.

Within the United Kingdom, the majority of health care is delivered through a publicly funded National Health Service (NHS). The hospital where this study was based was a large NHS teaching facility that had a busy emergency department. Within this department was a minor injuries unit (MIU), (3) which is an emergency health care service specifically for nonlife-threatening injuries. Its purpose is to alleviate pressure on the main emergency department. Patients with minor injuries and moderate illnesses are triaged in the emergency department to the MIU. MIU patients need some investigation or treatment, but are highly unlikely to need hospital admission. (3) In the United Kingdom, most large hospitals have an MIU, which normally is not staffed by physicians.

The MIU in this study is an advanced practitioner-led service staffed by emergency nurse practitioners (ENPs) and an extended-scope physiotherapist (ESP). Both ENPs and ESPs are qualified and state-registered professionals in their respective fields. Additionally, they have undertaken postbasic training in advanced clinical roles, enabling them to work competently in an MIU. The 19 qualified ENPs work on a rotation between the teaching hospital's emergency department and the MIU. They spend approximately 50% of their time in each of these facilities.

This study evaluates the impact of a radiographer image-reading service that supports an MIU based in a UK emergency department.

Literature Review

Previous research (4-7) has shown that image reading by radiographers can be as effective as that offered by radiologists. Table 1 combines image-reading performance data on radiographers from several published articles. In all of these articles, the radiographer's written report was compared to that of a radiologist and objective performance measures were calculated for sensitivity, specificity and accuracy. Sensitivity is the percentage of patients with the pathology with a positive result. It describes how good the radiographer is at picking up the pathology when it is actually present. Specificity is the percentage of patients without the disease who have a negative test result. Accuracy is the percentage of results that are identified correctly as positive or negative. As Table 1 demonstrates, the combined mean radiographer's ability is excellent, with a mean accuracy of 96.4%, a mean sensitivity of 94.91% and a mean specificity of 96.14%.

An additional finding of the studies included in Table 1 was that the turnaround time for written reports improved compared with a radiologist-only service. Furthermore, in 2002 Brealey (8) confirmed a strong acceptance of radiographer reporting in emergency departments by a range of health care professionals, including physicians. Published evidence, therefore, establishes that image-reading radiographers perform at a high...

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