Case Studies

Cornwall’s Cardiac CT Service

HeartFlow would like to take a moment to recognise sites that are going above and beyond to deliver an outstanding cardiac CT service to patients, especially during this COVID pandemic.

We are excited and proud to recognise the Royal Cornwall Hospitals NHS Trust for their Outstanding Cardiac CT Service!

Overview of Cornwall’s Cardiac CT Service

In 2019, Cornwall experienced a surge in referrals for cardiac CT, as more centres across England adopted NICE’s CG95 CT-first guidelines. The team looked to tackle incremental efficiencies to increase scanning throughout by mapping out protocols and patient flows to ensure shorter lists and efficient patient visits. However, they continued to struggle with the sheer number of referrals coming through.

Then, as a key consultant went on planned maternity leave, Cornwall realised that they were going to have to decrease the number of cardiac CT lists per week. Cornwall realised they needed to increase staff flexibility to ensure they could maintain and expand their cardiac CT service, and combat the risk of lists being cancelled.

Solution

Cornwall drew up a solution to start running radiographer-led cardiac CT lists to increase the number of cardiac CT lists a week. During radiographer-led cardiac CT lists, radiographers were able to both oversee patient scans and administer appropriate beta blocking. Cardiac CT-trained consultants are not in the department when radiographer-led cardiac CT lists are run, making this a fully independent programme.

Benefits

  • Fewer outstanding patients waiting for cardiac CTs
    • Since implementing radiographer-led services, Cornwall saw a sharp decrease in patients waiting to be scanned. (They reduced the patient backlog from 107 patients outstanding prior to initiating radiographer-led lists down to 6 patients as of November 2020.)
  • Flexibility to run additional cardiac CT lists
    • Ability to double the number of cardiac CT lists to catch up on any backlog, if necessary
    • Easier to schedule and run one more radiographer-led list
  • Resource management
    • Free up time for consultants to focus on other activities like CT interpretations and reporting
    • The cardiac CT lists that continue to be led by consultants are typically filled with more complex, higher risk patients
  • CT Quality and radiation dose
    • From Cornwall’s data audit, radiographer versus consultant-led lists have no difference in cardiac CT quality with 96% of 343 scans and 94% of 505 scans, respectively, rated as diagnostic.
    • While radiographer-led cardiac CT lists are constrained to a maximum of 15 mg beta blockers, there is no difference in radiation doses compared to consultant-led lists

Implementation of Service

  • Started with a 3-month trial period with consultants in the room next door in case of emergencies.
  • Kept program small initially to ensure radiographers had specialized skills for cardiac CT and could grew in confidence to make strong decisions.
  • Clear protocols for administration of beta blockade and necessary escalation policies.
  • Extended and continuous training for the radiographers, with the following focus:
    • What if scenarios – BB concerns, GTN concerns
    • Frequent meetings with the radiographers to discuss learnings and best practices
    • Strong support from consultants
  • Since reporting was done later, in rare instances, radiographer learned to document any scanning issues with the patients, so consultants know if they needed to recall the patient.

Today, the Royal Cornwall Hospital utilises a hybrid approach for their cardiac CT service – about half of the lists each week are radiographer led, while consultants supervise the other half. Consultants typically supervise lists with more complex patients based on referral details. Radiographer-led lists have allowed Cornwall to be nimble and flexible to reduce their outstanding cardiac CT patient lists even throughout the COVID pandemic.

Cornwall’s ability to be flexible, maximize resource utilization, and commitment to high quality cardiac CT is truly world class, and we, at HeartFlow, are so proud to be working with them to enhance heartcare for their patients.

The demand for cardiac CT examinations has increased 3-fold in the last couple of years following emerging evidence and national guidance to increase its use in patients with suspected heart disease. Without the hard work, ingenuity and dedication of our cardiac CT Radiographers, the RCHT CT department would not have been able to meet this challenge. Their contribution has been outstanding and sets standards for other centres.

Dr Andrew Edwards | Consultant Radiologist, RCHT


Not pictured Mohammed Abubakr (Consultant Cardiology) and Andrew Edwards (Consultant Radiology) who were instrumental in starting and advocating for radiographer led CT lists.

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