Instant bedside review of mobile CXR’s using Direct Capture Mobile X-Ray Presenter: Ryan Midgley

1. Innovation Poster Session HRT1215 – Innovation Awards Sydney 11th and 12th Oct 2012 Instant bedside review of mobile CXR’s using Direct Capture Mobile X-Ray Presenter: Ryan Midgley Hospital Code Name: Royal Adelaide Hospital

2. KEY PROBLEM The issue was time delay for a diagnosis of acute chest pathology and confirmation of line positions for doctors, and the best use of staff for mobile examinations.

3. AIM OF THIS INNOVATION Improvement Sought was to decrease the time delay to review mobile x-rays, and to give a more efficient service by better managing radiographers time.

4. BASELINE DATA Our old system of imaging using Computed Radiography takes approx 20 min from taking the x-ray to view and image. With DR the requesting doctor can view an image instantaneously (at the bedside). Most of all we can image multiple patients one after the other without returning to the department and processing images. The 2 Graphs below demonstrate the time to view a single x-ray and then the time to view an image when 3 patients are x-rayed without returning to the department. This Graph shows that no matter how many patients are imaged DR ensures no delay for the referrer to view images, however CR has at minimum a 15 minute delay

5. KEY CHANGES IMPLEMENTED Purchase of a DR mobile – Key change Introduction of Electronic Ordering – Streamline workload management - OACIS Use of Text Messaging paging service – Ability to inform radiographers of patients details requiring Mobile examinations while on ward without returning to department Dr is requested to be on the ward when we do the mobile

6. OUTCOMES SO FAR Image review is now possible at patients bedside as soon as the image is taken No delay for doctors when looking at lines eg, NGT, ET, PICC – Decreased time to administer medication, feeds. Lines able to be re positioned if required and a follow up x-ray can be taken immediately without the radiographer returning to the department If image is of sub optimal standard x-ray can be repeated immediately without returning to the department then back to patients bedside to re x-ray – 100% increase in productivity No need for radiographers to return to the department between x-rays eliminating delay to image multiple patients Better Image quality higher resolution with outstanding image quality – More diagnostic images Ability to halve exposures – decrease in dose to patient and staff, Have decreased the Number of Mobile machines in the department from 5 to 3 due to the increase in efficiency $100K/5yr DR Mobile is now expected by clinicians on the ward!!

7. LESSONS LEARNT Purchase of a lighter wireless DR mobile – Corded systems are bad for infection control purposes and earlier detectors are heavy Ability to retrofit existing Machines now possible – Make use of existing analogue equipment Use of text paging service if available is extremely efficient as is the use of a portable phone When Radiographer heads off to the ward make sure Dr requesting will be there to review image, saves radiographer waiting for Dr to view images If possible wireless RIS and PACS would allow for instant upload and downloads of images and work list to PACS for radiologist review.