Introduction

Turnaround time (TAT) in imaging is the interval between an imaging examination and a verified report being made available to the referring clinician. Keeping TATs as short as possible is essential for the timely diagnosis and treatment of patients.

In 2018, the Care Quality Commission’s (CQC) review of NHS radiology services in England found variation in TAT for reporting imaging examinations, and a lack of clear national guidance. The Care quality Commission (CQC) recommended that the NHS England National Imaging Board should produce national guidance for imaging reporting turnaround times.

Since then there have been several important related developments in imaging and diagnostics, including the publication of Diagnostics: recovery and renewal, establishment of community diagnostic centres and changes to the structure of the NHS with the Health and Care Act 2022.

The TAT guidance comes into effect on 9 August 2023. NHS providers, foundation providers and imaging networks should implement reporting against them immediately thereafter.

The expected TATs will act an enabler to help providers hit 62-day and faster diagnosis standards given the clear link between reporting delays and faster diagnosis and treatment for patients. 

Below we set out the new national TAT guidance in England for imaging reporting TATs across clinical pathways, including the maximum timeframe within which all imaging must be reported.

We also provide advice on the implementation and achievement of the TATs, and explain the reporting and monitoring requirements that will support their delivery.

About the turnaround times

The guidance seeks to reflect and codify existing best practice in reporting TATs, and while they are new, the TATs should not be unfamiliar or unachievable.

The priority TAT (see below) is that no examination should take longer than 4 weeks to be reported. This maximum timeframe has been set with reference to the current workforce and capacity limitations. The current guidance is considered a stepping stone to more ambitious TATs (e.g. 2 weeks) for consideration in the future.

All imaging departments and networks should aspire to achieve faster TATs than those set in the guidance, where capacity allows. Many units are already doing so. The Diagnostic Imaging Dataset (DID) 2021/22 shows that >84–94% of imaging studies (cross modality) are reported within 2 weeks.

Where this is not currently possible, imaging departments should be improving their reporting infrastructure so that they can deliver a maximum 2-week reporting for all imaging examinations in the near future. This will be achieved through workforce planning, working across imaging networks and developing insourcing models.

The expected TATs depend on the patient’s referral pathway. Please note the differential targets according to urgency and referral source set out below.

Imaging departments may have local agreements in place to manage examinations where a written formal radiology report is not required and instead provide a standard automated report. We expect all auto-reported examinations to meet the TAT guidance. Providers will need local processes in place to ensure these examinations are auto-reported without delay.

Imaging reporting TATs

Priority

No verified report should take longer than 4 weeks to be provided after image acquisition, under any circumstance

Any report at risk of taking longer than 4 weeks should be insourced or outsourced, with insourcing preferred (within the imaging department or across the imaging network).

Best practice is to continuously aim for reporting TATs that exceed the guidance through increased efficiency using measures such as:

• subspecialty reporting
• network collaboration
• ring-fenced reporting time for all professional groups who undertake reporting
• optimised digital connectivity for reporters.

Pathways

Table 1 below sets out the TAT guidance for the main referral categories across imaging services.

Table 1: TAT by referral category for imaging services

Implementation

The TATs are based on there being full staffing available to deliver them. Where there are known limitations in workforce capacity, it may be difficult to meet them immediately. We expect providers to take reasonable steps to resolve any workforce capacity issues, including by planning for increased capacity and making provisions for network-level reporting arrangements.

We expect that imaging examinations are reported using internal resources within each imaging department or network. Outsourcing of reporting should be an exception but may be necessary where a full reporting workforce is not in place.

Adherence to the TATs will rely on good digital connectivity, IT infrastructure, home working solutions and approved insourcing models established across imaging departments and networks.

Standard operating procedures (SOPs) should be in place for monitoring imaging reports and reporting on performance against TATs. This will allow early intervention to support improvements. Systems must be in place to ensure verified reports reach referrers in a timely fashion, as well as fail-safe systems for the communication of urgent or unexpected findings.

Local SOPs should be approved by all departments; they should reflect local priorities and what constitutes ‘urgent’, ‘emergency’ and ‘time critical’ findings should be agreed. Please refer to The Royal College of Radiologists’ guidance Recommendations on alerts and notification of imaging reports, published 3 October 2022.

Provider-level considerations

Providers should take the following steps in the order shown:

1. Review local provider policy to ensure imaging report TATs are in line with national guidance.
2. 9–5pm or ideally annualised job plan in hours, with agreed protected reporting sessions for all workforce groups for whom reporting is a component of their job plan.
3. NHS provider/NHS imaging network insourcing solution with agreed rates of pay. This insourcing model should include reporting radiographers working within their scope of practice and senior radiology trainees working within agreed competency parameters.
4. Outsourcing to a preferred provider, eg limited liability partnership at a provider or network level.
5. Outsourcing to an alternative provider, eg other teleradiology company.
6. Outsourcing should be used if in-house insourcing capacity is fully employed within the required timescale. Arrangements for this need to be in place in case outsourcing is needed to avoid a department falling outside the national guidance.

Network-level considerations

1. SOPs should be in place across imaging networks to ensure compliance with the national guidance.
2. Reporting TATs that exceed the guidance should be each department’s and network’s overall aim. Providers should develop network-level plans to achieve full compliance with the guidance, but also to use networks and improve digital connectivity to make 2-week reporting TATs achievable.
3. The TATs should be delivered through increased efficiency using measures such as: subspecialty reporting, network reporting models, network monitoring of waiting lists, ring-fenced reporting time for all professional groups undertaking reporting, and improved digital infrastructure to optimise digital connectivity for reporters of imaging examinations.

Monitoring

Performance against the expected TATs will form part of the regular DID reporting to NHS England, and we will use this to monitor compliance with the TAT guidance. Through ‘use of resources’ assessments we will consider this data when making judgements on diagnostic performance.

Where the TATs are not met due to known workforce capacity issues, we will expect providers to show that they are taking sufficient reasonable steps to confirm that available capacity is being used as productively as possible. Gaps in workforce should be addressed where possible by ensuring robust workforce plans include the number of trainee reporting posts required per year to meet demand.

Currently, reporting of most imaging tests already fall within the guidance. Based on data in the DID, which measures time to report in days, in Q4 2021/22 only 1.0% of examinations were reported outside the 4-week TATs.

Initial local monitoring

Local monitoring of compliance against the guidance will be required, with clear escalation routes in place for any reports due to fall outside the TATs (eg escalation to providers executive board and imaging network board).

Initial national monitoring

DID data will be used to report on the TATs listed in Table 2.

Table 2: Imaging service TATs which DID data can currently report

Two limitations of current DID data mean we cannot initially monitor and report on all national TATs:

• DID measures time in days. Any test that is completed in less than one day will be reported as 0. Therefore, it will not be possible nationally to report accurately on TATs shorter than one day.
• DID does not track referral type or priority. Therefore, it will not be possible to nationally report on TATs for ‘urgent’ referrals.

From the outset, DID tracking will include the following:

• 4-week TAT – any TAT over 4 weeks will be reported. Recommend using data to investigate causes for delays.
• Median reporting TAT total, in days, broken down by the referrer type within DID (inpatient, A&E, day cases, direct access and outpatient).

NHS England will begin publishing this data this year on our website Statistics » Diagnostic Imaging Dataset (england.nhs.uk) for the following examinations: CT, PET-CT, SPECT, MRI, plain film, nuclear medicine, ultrasound and fluoroscopy.

The NHS England Performance team continues to work with providers to improve DID data quality by reducing the percentage of ‘not knowns’ in submissions.

Monitoring post DID refresh

We will expand the monitoring and reporting to cover the full set of TATs once the DID data refresh has been fully implemented.

The DID refresh will introduce the capability to track TATs in minutes and to capture the urgency of requests.

Acknowledgments

The National Imaging Board on behalf of NHS England thank The Royal College of Radiologists, The Society and College of Radiographers, and by Hayley Connoley, Operational Services Manager at Hampshire Hospitals NHS Foundation Trust for their contributions to developing this guidance. 

Publication reference: PR1753