Radiographer role extension: a paradigm shift in practice.

1. S Mathers*+, G McKenzie*, +The Health Services Research Group, The Robert Gordon University, *NHS Grampian Aberdeen, Scotland, UK. Radiographer role extension: a paradigm shift in practice.

2. Political NHS organisations are accountable for continuously improving the quality of the service New roles are encouraged to demonstrate innovations and (hopefully) improve quality A First-class Service, Quality in the NHS, 1998 Factors leading to radiographer role extension

3. Staff ‘The traditional demarcations between staff have held services back ...the provision of health services should depend on the ability of the staff, not their job title.’ A Health Service for All Talents – Developing the NHS Workforce, Dept of Health, 2000

4. Radiology serious shortage of radiologists increasing waiting lists for procedures year on year increase of examinations performed - additional demands on radiologist’s time

5. Medical practitioners may delegate medical care to non-medical health care staff – but the MP must be sure that the staff are competent ... to carry out that task. Such health care workers must be accountable to a statutory body, i.e. state registered. GMC, Good Medical Practice, 1995 Guidance on delegation of tasks

6. www.sor.org www.rcr.ac.uk

7. In the areas of - GI, e.g. radiographer performed barium enemas - Ultrasound, e.g. general diagnostic US, O&G Intravenous injections of contrast media - IVU, CT, nuclear medicine Reporting of images - skeletal, US, GI, nuclear medicine, mammography, Angiography, e.g. peripheral angiograms Main areas of role extension

8. Initially hospital based e.g. St James’ Leeds Barium Enema Course Courses now University led e.g. Salford University You must have a supportive and enthusiastic radiologist Training

9. Letter of agreement of radiographer role extension - task(s) delegated - to whom delegated - who is responsible - name(s) of radiographer(s) involved and training - name(s) of supervising radiologist(s) Signed by clinical manager and Hospital Manager Radiographer must be insured - Trust Indemnity Insurance AND - Personally (usually through SoR) Requirements between Dept and Hospital Management

10. The main aims were to: determine characteristics of radiographers who performed BE establish current practices - ascertain benefits and drawbacks of performing BE Radiographers experience of performing barium enemas

11. Sample - convenience sample of 68 radiographers (GIRSIG members) Postal questionnaires - total of 20 questions (17 closed) - in 3 sections performing BE other duties personal information Study design

12. 71% response rate (n=48/68) Results

13. Characteristics • mean age 43 years (range 25-56 years) • 76% (n=34) female • 24% (n=11) male

14. Motivation

15. % n more than 80% 47 21 50% - 80% 33 15 less than 50% 20 9 % of total BE performed by radiographers in their department

16. 16% (n= 7) reported own enemas without input from radiologists Reporting

17. Performing other fluoroscopy procedures (n=27)

18. % n Increased job satisfaction 66 29 Providing better service for patients 64 28 Increased contact with other staff 45 20 Raised profile of profession 37 16 Increased knowledge and expertise 25 11 Main benefits of performing barium enemas

19. % n Radiologist attitude 30 11 Lack of recognition of responsibilities 24 9 Lack of radiography staff 22 8 Lack of time for reporting 19 7 Limitation of further CPD 19 7 Main drawbacks of performing barium enemas

20. expectations have been fulfilled concerns do exist implications for the expansion of the service Conclusions

21. reluctance of radiologists to delegate tasks increasing shortage of radiographers reluctance of radiographers to embrace the use of assistant practitioners BUT there are obstacles

22. USA - since 2003 training courses for technologists to perform BE, intravenous injections etc - they will be known as radiologist assistants - do not want to report New Zealand - radiographers performing BE Experience outside UK

23. radiographers role extension becoming the norm in UK number of specialty area increasing increasing job satisfaction new career pathways for radiographers Assistant practitioner Practitioner Advanced practitioner Consultant Conclusions

24. Radiographers should provide the utmost service for radiologists Furby, Radiography, 1944 Radiographers can distinguish between normal and abnormal Swinburne, Lancet, 1971 Radiographers can report fracture radiographs Loughran, BJR, 1994 Radiographer performed BE provide an excellent quality examination with results comparing favourably with published data (for radiologists) Law et al, Clin Rad, 2002 Paradigm shift?