Tudor
it might be worth raising the following points with your email group
regarding implementation of NICE head injury guidelines -

1. Figures from one English hospital indicates an increase in total head
scans by 2150% (4 to 86 in one month)
2. Out of hours service would rise by 2900% (2 to 58)
3. There is no extra work for A/E departments in this but there is a huge
change in work for radiology.
4. Most services run with on call radiographers.  If these people are out at
night then they are due time off (WTD) during the day.  This then impacts on
the ability of departments to carry out routine imaging. The reduction in
SXR does not directly relate to CT on call as different staff are often
used.  A single on call radiographer cannot be imaging fractured wrists and
doing another  CT brain.
5. Extra day time CT cases will impact on some hospitals who have long CT
waiting times.
6. If these changes are to go ahead they need costed and full reimbusement
to the radiology services.  This would of course come from the clinical
departments (such as A/E) who would make savings as they would not be
admitting as many cases. (!!!!!) (At least NICE say there will be savings
but these are not necessarily realisible as the wards, beds and staff who
currently look after head injuries will still ned to be there for other
cases.)
7. Even if funding is made available, it would require radiology units to
look at shift pattern working and at present there is a huge shortage of
radiographers.
8. Interpretation of images out of hours is perhaps less of a problem as
radiologists at home would be able to use electronic review, but they too
would fall foul of the WTD which would mean fewer radiologists free to do
the daytime work. (And there is currently a shortage of radiologists.)
9. Not all radiology departments resist change - but there is a constant
battle to get ALL clinical services to realise that if changes are made in
clinical services then radiology MUST be included in early discussion if the
proposed change requires imaging. (Similarily for labs, path etc.)  Until
clinical departments fully cost new developments they will meet resistance
from radiology because what one clinical specialty sees as a simple change
will only be one of many demands being made for scare radiology resource.
10.  These proposals have a massive, nationwide implication. (I am writing
from Scotland where NICE does not apply, but the College of Radiologists has
recently included the NICE proposals in its new guidelines book which is
sent to us Jocks!)  There is a need for very senior management at health
board / health authority level to discuss the implications as many
individual departments simply will not be able to cope.


John Addison
Consultant Radiologist
Dr Grays Hospital
Elgin
Moray



        Dr. Tudor Codreanu MSc(Med)
        Staff Grade
        Accident and Emergency Dept.
        Dr. Gray's Hospital
        Elgin
        tel: 01343 543131 ext 67360
        dir: 01343 567360
        fax: 01343 552612
        e-mail: [log in to unmask]

        -----Original Message-----
        From:   Tom Hughes [SMTP:[log in to unmask]]
        Sent:   28 November 2003 23:35
        To:     [log in to unmask]
        Subject:        Re: missed fractures in A/E and a bit about NICE
[Scanned By SOPHOS Anti-Virus]

        re reluctance to implement NICE guidelines.

        A possible stick I have heard used successfully in similar
situations is
        this:

        Say to your medical insurance agency- NICE says this, my hosptial
says
        'no', are you still happy to cover me? Medical insurance writes back
        'no, we are not happy to cover you'.
        Show letter to managers.
        Managers may not be scared of doctors, but they are sure as hell
scared
        of lawyers.

        Tom


Dr. Tudor Codreanu MSc(Med)
Staff Grade
Accident and Emergency Dept.
Dr. Gray's Hospital
Elgin
tel: 01343 543131 ext 67360
dir: 01343 567360
fax: 01343 552612
e-mail: [log in to unmask]

> -----Original Message-----
> From: Andy Webster [SMTP:[log in to unmask]]
> Sent: 30 November 2003 20:30
> To:   [log in to unmask]
> Subject:      Re: missed fractures in A/E and a bit about NICE [Scanned By
> SOPHOS Anti-Virus]
>
> Doncaster nearly always have bed problems- amber/red alert surgical
> patients
> cancelled due to medical outliers
>
> -----Original Message-----
> From: Accident and Emergency Academic List
> [mailto:[log in to unmask]] On Behalf Of Adrian Fogarty
> Sent: 30 November 2003 14:13
> To: [log in to unmask]
> Subject: Re: missed fractures in A/E and a bit about NICE
>
> ----- Original Message -----
>
> Now, NICE guidelines. Our Radiology manager has agreed to most of the
> indications for scan within one hour but has objected to :-  a) Knocked
> out
> plus age>65 b) Knocked out plus on anticlogs. Note that this is the
> manager
> because the radiologists have so far declined even to talk about it. How
> goes it in the rest of the country? [John Paskins]
>
> Well that's very interesting, John. Perhaps you should point out that a
> normal CT in such patients will generally allow their safe discharge. Is
> this particular manager aware that any resource savings with respect to
> imaging will probably result in resource usage with respect to beds? Of
> course, if your trust doesn't have a bed problem then this is a reasonable
> approach to take. Most trusts, however, do have severe capacity problems
> with respect to beds, and most would sensibly opt to scan and discharge
> where possible. Or is this particular manager simply suggesting that you
> don't scan them but send them home anyway? This, in particular, needs to
> be
> clarified (see below).
>
> Managers may not be scared of doctors, but they are sure as hell scared of
> lawyers. [Tom Hughes]
>
> Spend lots of money now to fully implement guidelines or possibly spend
> lots later if something goes wrong! [Fred Cartwright]
>
> Quite! But it's not just a matter of taking the attitude "what the hell,
> I'm insured, aren't I?". Certainly, managers do not have to bear the
> triple
> burden of responsibility that doctors do, i.e. civil litigation, criminal
> prosecution and GMC censure, not to mention our ethical responsibilities!
> But perhaps management should be gently reminded that, while they may be
> indemnified against civil damages, it remains unclear as to whether other
> actions might result from their reckless or dangerous management
> decisions...
>
> Adrian Fogarty
>
>
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