Clinical standard 5: Diagnostics

Seven day access to imaging: Strategies to sustain improvements

Salisbury NHS Foundation Trust has sustained provision of seven day imaging services since implementation in 2011. Improvements include changing job plans and working arrangements for radiologists, radiographers and support staff, and increasing capacity by outsourcing overnight CT reporting and investment in additional scanners. As a result, there is improved access to urgent on-site CT, MRI and ultrasound services seven days a week. Reduced waiting times for elective imaging have been maintained despite an increase in workload of 20%.

Using an improvement method to review transfers of care seven days a week

NHS Improving Quality supported Buckinghamshire System Resilience Group (SRG) to review practice at Stoke Mandeville Hospital, to meet the 7 day service clinical standard 9: transfer of care, and to identify the focus for new initiatives in preparation for winter pressure planning. The review identified weekend/ weekday variation and opportunities for improvement. The evidence assisted the SRG to assure improvement plans, and the transferrable methodology used will benefit other healthcare communities check and challenge assumptions in relation to transfer of care issues.

Improving access to senior clinical decision makers and diagnostics seven days a week improvements

Royal United Hospitals Bath NHS Foundation implemented weekend consultant ward rounds, a seven day Emergency Surgical Ambulatory Care (ESAC) and an Assessment and Comprehensive Evaluation (ACE) of older people. These changes increased the availability of seven day access to senior clinicians and to diagnostics, reduced variation in the relative risk of mortality across the week, reduced the mortality risk at a greater rate than the national rate of improvement and reduced length of stay for frail older patients from 14.9 days in 2012/13 to 5.3 days in the first 6 months of ACE being implemented.

Delivery of a seven day microbiology service to facilitate earlier diagnosis and treatment

Northumbria Healthcare NHS Foundation Trust moved to a 24/7 on-site shift system to increase the timely reporting of patient’s results. This has contributed to improvements in the management of healthcare associated infections, including a 40% reduction in cases of C.difficile.

Utilising point-of-care testing and evidence based service redesign to establish an ambulatory emergency care (AEC) service

James Paget University Hospitals NHS Foundation Trust ran a pilot to establish AEC services which reduced patient waiting times in ED by 41% , saved 59 overnight stays and enabled the removal of 15 medical escalation beds. The pilot has resulted in a seven day commissioned AEC service.

Implementing a seven day ambulatory emergency care model

Southend University Hospitals Foundation NHS Trust (this is also under clinical standard 2).

One stop emergency surgery ambulatory care service commissioned for 7 days a week

Royal United Hospitals Bath NHS Foundation Trust (this is also under clinical standards 2 and 8).

Seven day elective cardiac surgery

Papworth Hospital NHS Foundation Trust (this is also under clinical standards 6 and 8).