The costs and effects of introducing selectively trained radiographers to an A&E reporting service: a retrospective controlled before and after study

Reporting radiographers in Europe survey: Support, role satisfaction, and advanced clinical practice within the European federation of radiographer society (EFRS) member countries

INTRODUCTION

Increasing number of radiographers are undertaking image reporting throughout Europe. However, there are variations in practice and experience in European countries. The study aim was to investigate reporting radiographer's perceptions in relation to support for their role and workload satisfaction and elements of advanced practice that may also be undertaken.

METHODS

Following institutional ethical approval an online 34 item questionnaire survey was circulated via social media; Twitter, Facebook, and LinkedIn in a 12-week period in 2022 across Europe. The survey data were managed by the online secure database REDCap (Research Electronic Data Capture). Data was collected across a range of questions, of which those relating to support for, and barriers to radiographer reporting, role and job satisfaction, and other role elements are reported here.

RESULTS

A response level of 345 individual reporting radiographers replied to the survey from 15 European countries; some questions were optional and therefore had a lower response rate. There was consensus about the need for support from radiologists and management, protected time, and funding to support the reporting role. The majority of respondents received additional pay for taking on this role and expressed satisfaction with their role and workload. In relation to elements of advanced practice, the majority of respondents were involved in educational and managerial activities, and there was interest, but limited involvement, in research.

CONCLUSION

There was a consensus about the support needed, and perceived barriers to, radiographer reporting, between reporting radiographers from different countries. Whilst there is some commonality in relation to activities such as supervision and education, there was clearer variety in relation to opportunities for research between the respondents, perhaps reflecting the differences between reporting as a standalone role development and reporting as part of an advanced clinical practice role.

IMPLICATIONS FOR PRACTICE

As there is increasingly an emphasis on advanced clinical practice, reporting radiographers are likely to require support to develop their skills so that they can actively participate in the broader activities associated with this role, including education, leadership, and research.

Assessing the barriers and enablers to the implementation of the diagnostic radiographer musculoskeletal X-ray reporting service within the NHS in England: a systematic literature review

INTRODUCTION

The United Kingdom (UK) government's healthcare policy in the early 1990s paved the way adoption of the skills mix development and implementation of diagnostic radiographers' X-ray reporting service. Current clinical practice within the public UK healthcare system reflects the same pressures of increased demand in patient imaging and limited capacity of the reporting workforce (radiographers and radiologists) as in the 1990s. This study aimed to identify, define and assess the longitudinal macro, meso, and micro barriers and enablers to the implementation of the diagnostic radiographer musculoskeletal X-ray reporting service in the National Healthcare System (NHS) in England.

METHODS

Multiple independent databases were searched, including PubMed, Ovid MEDLINE; Embase; CINAHL, and Google Scholar, as well as journal databases (Scopus, Wiley), healthcare databases (NHS Evidence Database; Cochrane Library) and grey literature databases (OpenGrey, GreyNet International, and the British Library EthOS depository) and recorded in a PRISMA flow chart. A combination of keywords, Boolean logic, truncation, parentheses and wildcards with inclusion/exclusion criteria and a time frame of 1995-2022 was applied. The literature was assessed against Joanna Briggs Institute's critical appraisal checklists. With meta-aggregation to synthesize each paper, and coded using NVivo, with context grouped into macro, meso, and micro-level sources and categorised into subgroups of enablers and barriers.

RESULTS

The wide and diverse range of data (n = 241 papers) identified barriers and enablers of implementation, which were categorised into measures of macro, meso, and micro levels, and thematic categories of context, culture, environment, and leadership.

CONCLUSION

The literature since 1995 has reframed the debates on implementation of the radiographer reporting role and has been instrumental in shaping clinical practice. There has been clear influence upon both meso (professional body) and macro-level (governmental/health service) policies and guidance, that have shaped change at micro-level NHS Trust organisations. There is evidence of a shift in culturally intrenched legacy perspectives within and between different meso-level professional bodies around skills mix acceptance and role boundaries. This has helped shape capacity building of the reporting workforce. All of which have contributed to conceptual understandings of the skills mix workforce within modern radiology services.

Reporting radiographers in Europe survey: An overview of the role within the European Federation of Radiographer Society (EFRS) member countries

INTRODUCTION

Reporting radiographers undertake an important role in healthcare and for the radiographer profession in general. First introduced in the United Kingdom, reporting radiographers are now practicing in several other European countries. Our objective was to investigate the workforce of reporting radiographers across the European Federation of Radiographer Societies (EFRS) community.

METHOD AND MATERIAL

A voluntary anonymous 34 item electronic survey was distributed online using social media accounts such as Twitter, Facebook and LinkedIn covering a wide range of topics relating to professional role, advanced practice, education, and seniority. The questionnaire was distributed during a 12-week period in 2022.

RESULT

A total of 345 individual responses were received from 15 countries with majorities of respondent from United Kingdom (n = 245, 71%) and Denmark (n = 66, 19%). Mean age was 41.9 (S.D 9.8), similar for females, 42.5 (S.D 9.0) and men 40.9 years (S.D 9.7). Most reporting radiographers worked in public hospitals (90%). The vast majority of the respondents (n = 270, n = 94%) authored and signed their own clinical reports while a minority (n = 18, 6%) stated that their reports were checked by radiologists.

CONCLUSION

The survey highlights the scope of practice of reporting radiographers working in Europe. Reporting is becoming a career path for an increasing number of radiographers across Europe and there is assess to academic education and clinical support.

IMPLICATION FOR PRACTICE

Reporting radiographers fulfil an important role within the current demands of healthcare. This demand is likely to increase in the future, and therefore it is vital that there is some form of standardisation in the level of education that this group of healthcare professionals receive.

How is the reporting radiographer role portrayed in published studies? A scoping review

OBJECTIVES

Radiographers have been undertaking reporting tasks since the 1980's with a wealth of evidence published to support this practice. Radiographers have since developed skills in reporting all body systems, from all referral sources across a range of modalities. Radiographer reporting is now considered established and demand for radiographers in this role is rising to meet service demand. Reporting radiographers work as part of multi-professional image reporting teams, it is unclear how the radiographer role is perceived as part of this model. The aim was to review peer-reviewed literature to evaluate how the role of the reporting radiographer is portrayed and how the relationship between the two imaging professions has developed.

KEY FINDINGS

Language used to discuss the role of the reporting radiographer has changed over time. There is progress demonstrated from the practice of radiographer reporting being considered contentious or opposed to accepted and established. Recent publications focus on the importance utilising the skills of all multi-disciplinary team members in workforce structure. This features prominently when discussing future workforce design, such as with the Cancer workforce strategy and the development of the national standards for musculoskeletal reporting.

CONCLUSION

Published literature has highlighted a move towards acceptance of the reporting radiographer role. Multi-disciplinary team working, utilising the skills of all imaging team members, is essential to the success and sustainability of the imaging workforce moving forwards.

IMPLICATIONS FOR PRACTICE

Reporting by radiographers is established and will be prominent in the reporting workforce as part of long-term workforce planning, considering skills mix to form effective and sustainable multidisciplinary reporting teams.

Characterising the outcomes, impacts and implementation challenges of advanced clinical practice roles in the UK: a scoping review

OBJECTIVES

In response to demographic and health system pressures, the development of non-medical advanced clinical practice (ACP) roles is a key component of National Health Service workforce transformation policy in the UK. This review was undertaken to establish a baseline of evidence on ACP roles and their outcomes, impacts and implementation challenges across the UK.

DESIGN

A scoping review was undertaken following JBI methodological guidance.

METHODS

13 online databases (Medline, CINAHL, ASSIA, Embase, HMIC, AMED, Amber, OT seeker, PsycINFO, PEDro, SportDiscus, Osteopathic Research and PenNutrition) and grey literature sources were searched from 2005 to 2020. Data extraction, charting and summary was guided by the PEPPA-Plus framework. The review was undertaken by a multi-professional team that included an expert lay representative.

RESULTS

191 papers met the inclusion criteria (any type of UK evidence, any sector/setting and any profession meeting the Health Education England definition of ACP). Most papers were small-scale descriptive studies, service evaluations or audits. The papers reported mainly on clinical aspects of the ACP role. Most papers related to nursing, pharmacy, physiotherapy and radiography roles and these were referred to by a plethora of different titles. ACP roles were reported to be achieving beneficial impacts across a range of clinical and health system outcomes. They were highly acceptable to patients and staff. No significant adverse events were reported. There was a lack of cost-effectiveness evidence. Implementation challenges included a lack of role clarity and an ambivalent role identity, lack of mentorship, lack of continuing professional development and an unclear career pathway.

CONCLUSION

This review suggests a need for educational and role standardisation and a supported career pathway for advanced clinical practitioners (ACPs) in the UK. Future research should: (i) adopt more robust study designs, (ii) investigate the full scope of the ACP role and (iii) include a wider range of professions and sectors.

An evaluation of CT head reporting radiographers' scope of practice within the United Kingdom

INTRODUCTION

This study investigated the scope of practice of CT head reporting radiographers in the UK, and to compare adherence to professional body standards.

METHODS

An online questionnaire was utilized applying both multiple-choice and response (closed questions), and qualitative open question free-text responses. The 30 questions covered four key areas of demographics, the scope of practice, referrals, and ongoing competence, as described in professional body national guidance standards. The questionnaire was disseminated (convenience sampling) via Twitter and email to the National CT Head Reporting Special Interest Group. Responses were transcribed and coded; the results applied descriptive statistics to summarise observations of the study sample.

RESULTS

The sample of participant response data analysed was n = 54. Most respondents were from England, with a postgraduate certificate award in clinical reporting, and a mean length of 8.3 years of reporting experience. The accepted referral pathway included a wide range of medical and surgical specialities, including both in and outpatients and acute and chronic pathways. Furthermore, 96.2% of the sample had a scope of practice that authorised referral recommendations to a broad and inclusive group of medical and surgical teams, and if required further or repeat diagnostic imaging. To maintain quality and evidence of ongoing competency, all radiographers were involved in audit cycles.

CONCLUSION

The data collected confirmed the reporting practice within this sample group aligns to national recommended guidance. The data provided key information on the range and variation of individuals scope of practice within age restrictions of patients, examination types, referral teams, and ongoing competency practices.

IMPLICATIONS FOR PRACTICE

This paper details the scope of practice of CT head reporting by radiographers and the contribution made to the healthcare sector.

CO-score; a new method for quality assessment of radiology reports

INTRODUCTION

Studies on assessing radiology reports commonly calculates sensitivity, specificity and accuracy, which estimates if the observer has tendency to overdiagnose, overlook pathology, or both. This pilot study examines a new method for assessing the quality of radiology reports, based on the patients' clinical outcome.

METHODS

Two observers evaluated five hundred reports by four experienced reporting radiographers on X-ray images of the appendicular skeleton. The observers categorised the reports as true or false and gradated the quality of the report from 1 to 3 based on the patients' clinical outcome. We developed a new performance score, called the Consequence of Clinical Outcome (CO-score), which combines the amount of incorrect reports and the severity of errors, to assess the overall quality of the reports. A low CO-score represents high quality with few or inconsiderate errors.

RESULTS

The results showed no direct connection between high accuracy and low CO-score. All radiographers achieved high levels of accuracy (range: 96.8%-100%) but varied in CO-score (range: 0.00-0.14). One radiographer achieved an accuracy of 97.6% but a high CO-score of 0.14 as four reports had clinical consequence for the patients and five reports lacked minor details. One report was classified as true positive but was inadequate and led to wrong treatment.

CONCLUSION

This study shows that true reports can affect the patients' clinical outcome and reports classified as false can represent insignificant errors. The new CO-score gives a more nuanced view of the reporting quality by including the patients' clinical outcome in the performance score.

IMPLICATIONS FOR PRACTICE

We suggest that the CO-score is included as a supplement to the common methods in future studies assessing the quality of radiology reports as well as in clinical audits.

Image interpretation by radiographers in brain, spine and knee MRI examinations: Findings from an accredited postgraduate module

INTRODUCTION

The aim of the study was to evaluate the performance of radiographers in image interpretation of magnetic resonance imaging (MRI) brain, spine and knee examinations following a nine-month work based postgraduate MRI module.

METHODS

Twenty-seven participants each submitted 60 image commentaries taken from prospective clinical workloads. The image interpretations (n = 1620) comprised brain, spine, and knee MRI examinations. Prevalence of abnormal examinations approximated 53% (brain), 74% (spine), and 73% (knee), and included acute and chronic pathology, normal variants and incidental findings. Each image interpretation was graded against reference standard consultant radiologist definitive report.

RESULTS

The radiographer's performance on brain image interpretations demonstrated mean accuracy at 86.7% (95% CI 83.4-89.3) with sensitivity and specificity of 84% (95% CI 80.9-86.4) and 89.7% (95% CI 86.2-92.6) respectively. For spinal interpretations the mean accuracy was 86.4% (95% CI 83.4-89.0), sensitivity was 90.2% (95% CI 88.2-92), mean specificity was 75.3% (95% CI 69.4-80.4). The mean results for knee interpretation accuracy were 80.9% (95% CI 77.3-84.1), sensitivity was 83.3% (95% CI 80.8-85.5), with 74.3% specificity (95% CI 67.4-80.4).

CONCLUSIONS

The radiographer's demonstrated skills in brain, spine and knee MRI examination image interpretation. These skills are not to replace radiologist reporting but to meet regulating body standards of proficiency, and to assist decision making in communicating unexpected serious findings, and/or extend scan range and sequences. Further research is required to investigate the impact of these skills on adjusting scan protocols or flagging urgent findings in clinical practice.

Does radiography advanced practice improve patient outcomes and health service quality? A systematic review

OBJECTIVE

To investigate the impact of radiographer advanced practice on patient outcomes and health service quality.

METHODS

Using the World Health Organization definition of quality, this review followed the Centre for Reviews and Dissemination guidance for undertaking reviews in healthcare. A range of databases were searched using a defined search strategy. Included studies were assessed for quality using a tool specifically developed for reviewing studies of diverse designs, and data were systematically extracted using electronic data extraction pro forma.

RESULTS

407 articles were identified and reviewed against the inclusion/exclusion criteria. Nine studies were included in the final review, the majority (n = 7) focusing on advanced radiography practice within the UK. Advanced practice activities considered were radiographer reporting, leading patient review clinics and barium enema examinations. The articles were generally considered to be of low-to-moderate quality, with most evaluating advanced practice within a single centre. With respect to specific quality dimensions, the included studies considered cost reduction, patient morbidity, time to treatment and patient satisfaction. No articles reported data relating to time to diagnosis, time to recovery or patient mortality.

CONCLUSION

Radiographer advanced practice is an established activity both in the UK and internationally. However, evidence of the impact of advanced practice in terms of patient outcomes and service quality is limited.

ADVANCES IN KNOWLEDGE

This systematic review is the first to examine the evidence base surrounding advanced radiography practice and its impact on patient outcomes and health service quality.

Factors that Influence Radiographers' Decisions to Pursue Postgraduate Education: An Exploratory Qualitative Study

BACKGROUND

Radiography has continued to expand since the discovery of x-rays with newer technologies and responsibilities for radiographers. Consequently, radiographers need to learn new skills in order to remain relevant in health care. Radiography currently needs a generation of radiographers who can also get engaged in research and advance the profession through evidence-based practices. Achieving this requires radiographers to be trained above the basic qualification, yet there are still few radiographers embarking on postgraduate education. The purpose of this study was to explore factors that influence radiographers' decisions to pursue postgraduate education, as well as explore ways of improving access to such education.

METHODS

An exploratory qualitative study was conducted with postgraduate radiography students at Cardiff University. Purposive convenience sampling was used to recruit participants. Data were collected using individual face-to-face interviews, which were then analyzed using thematic analysis and summarized into themes and subthemes.

RESULTS

There were nine participants interviewed, providing adequate data saturation. Of the nine, three were female and six were men. Eight of them were basic radiographers, whereas one was a senior radiographer. Radiographers were influenced by intrinsic and extrinsic factors when deciding to pursue postgraduate radiography education. Key intrinsic factors included desire for personal professional development, desire for new challenges, and search for satisfaction within the profession. Key extrinsic factors included requirements for continuous professional development, availability of funding, and search for improved remuneration. Key suggestions for improving access to postgraduate education were identified.

CONCLUSIONS

Both external and internal factors simultaneously influence radiographers' decisions to embark on postgraduate education, and all these factors need to be addressed in order to improve access to such education for radiographers.

Evidence of reference standard related bias in studies of plain radiograph reading performance: a meta-regression

The aim is to determine the effect of reference standard related bias on estimates of plain radiograph reading performance using studies conducted in clinical practice. Data were extracted on study eligibility, clinical and reference standard characteristics and reading performance. The choice of reference standards and the prevalence of bias are presented descriptively. Associations between bias and reading performance are estimated using a regression model that produces relative diagnostic odds ratios (RDOR) with 95% confidence intervals (CIs). Three of the 20 eligible studies addressed all five reference standard related biases; 15 studies addressed three or more. When the reference standard report is influenced by knowledge of an observer's opinion this is associated with a significant overestimation in reading performance (RDOR, 3.7; 95% CI, 1.6 to 8.3; p = 0.01). There is limited evidence that reading performance is inflated when the observer is aware of the reference standard report before commenting on the radiograph (RDOR, 1.7; 95% CI, 0.6 to 5.1) and deflated when a less valid reference standard is used (RDOR, 0.5; 95% CI, 0.1 to 2.5). There is no evidence that reading performance is affected by application of the reference standard depending on an observer's opinion and using different reference standards in the same study. In conclusion we found variation in the choice and application of reference standards in studies of plain radiograph reading performance, but only when reference standards report in the knowledge of an observer's opinion does this contribute to a significant overestimation in reading performance.

Accuracy of radiographers red dot or triage of accident and emergency radiographs in clinical practice: a systematic review

AIM

To determine the accuracy of radiographers red dot or triage of accident and emergency (A&E) radiographs in clinical practice.

MATERIALS AND METHODS

Eligible studies assessed radiographers red dot or triage of A&E radiographs in clinical practice compared with a reference standard and provided accuracy data to construct 2 x 2 tables. Data were extracted on study eligibility and characteristics, quality, and accuracy. Pooled sensitivities and specificities and chi-square tests of heterogeneity were calculated.

RESULT

Three red dot and five triage studies were eligible for inclusion. Radiographers' red dot of A&E radiographs in clinical practice compared with a reference standard is 0.87 [95% confidence interval (CI) 0.85-0.89] and 0.92 (0.91-0.93) sensitivity and specificity, respectively. Radiographers' triage of A&E radiographs of the skeleton is 0.90 (0.89-0.92) and 0.94 (0.93-0.94) sensitivity and specificity, respectively; and for chest and abdomen is 0.78 (0.74-0.82) and 0.91 (0.88-0.93). Radiographers' red dot of skeletal A&E radiographs without training is 0.71 (0.62-0.79) and 0.96 (0.93-0.97) sensitivity and specificity, respectively; and with training is 0.81 (0.72-0.87) and 0.95 (0.93-0.97). Pooled sensitivity and specificity for radiographers without training for the triage of skeletal A&E radiographs is 0.89 (0.88-0.91) and 0.93 (0.92-0.94); and with training is 0.91 (0.88-0.94) and 0.95 (0.93-0.96).

CONCLUSION

Radiographers red dot or triage of A&E radiographs in clinical practice is affected by body area, but not by training.