Salisbury, Wight, and South Hampshire Domain NHS Trust (SWASH)
Patient care on the south coast of England is being significantly enhanced by a new picture archiving and communication system (PACS). Clinicians and radiologists are seamlessly sharing and accessing imaging and reports in a way like never before, resulting in major benefits for patients being treated across the SWASH consortium of NHS Trusts.
Providing a holistic view of the patient’s data and any relevant prior imaging has benefited our patients immensely.
The Salisbury, Wight and South Hampshire Domain NHS Trust (SWASH) has acquired technology that is allowing hospitals to deal with patients holistically as they are treated across the region. Member Trusts’ new radiology IT systems are changing the landscape for how clinicians interact with radiology images and how patient care is delivered. Here is their story.
The end of National Programme for IT and its Local Service Provider (LSP) contracts for radiology systems created a new opportunity for NHS Trusts. The challenge was to enable better collaboration between all the Trusts, integrating all systems so they can deliver better, efficient and safer care. Trusts needed to save money, take control of contracts, be able to “tailor” products to needs and address multiple integration needs not met under the LSP.
At the outset, the consortium had:
The SWASH consortium’s answer: Real-time cross-platform access.
The rapid deployment of Sectra PACS has been central to sharing critical patient information.
Medical professionals across SWASH, which includes University Hospital Southampton NHS Foundation Trust, Isle of Wight NHS Primary Care Trust, Portsmouth Hospitals NHS Trust, Solent NHS Trust, Salisbury NHS Foundation Trust and Hampshire Community Healthcare, now benefit from real-time seamless access to radiology images and reports from any of the SWASH organisations.
“We are entering a new era in PACS for the south coast,” says Dr Mark Griffiths, the clinical lead for the SWASH consortium. “We most definitely have a more streamlined solution. Patients can now go to the hospital of their choice and clinicians can now log into one system and see relevant data from other hospitals.”
Dr Griffiths, a paediatric radiologist who is also chair of the UK Imaging Informatics Group, says the entire clinically led system has been designed around how patients move around the region. “Patients would have imaging at different sites. We needed to make sure the patient pathway was served by the imaging.”
Unnecessary repeat x-rays and other imaging could have taken place before the new PACS because radiologists previously lacked visibility of imaging from other Trusts.
Using Sectra Cross Platform Worklists radiologists and clinicians now have streamlined access to the patient’s history and can instantly see if imaging has been carried out at other sites and this is delivering results. “They can see across the borders of our Trust.”
In a BBC recording from May 2018, recently retired Lorna Bennett shares her most memorable moment working in the informatics department at Salisbury District Hospital—listen to how medical imaging and a cross-platform workflow in the SWASH consortium improved a critically injured patient’s care.
“Providing a holistic view of the patient’s data and any relevant prior imaging has benefited our patients immensely,” says Dr Griffiths. For example, patients can expect a far better experience now that clinicians can improve their diagnostic accuracy with instant access to the whole view of the patient’s history.
Improved access to information will also reduce costs for the NHS and not only because of the reduction in avoidable imaging. Initially, the consortium expected to achieve a 20 per cent cost reduction through the use of technology. “That was just on up-front costs,” explains Dr Griffiths. “It didn’t include anything like clinician time outside of radiology. That is where we are making hidden cost savings.”
“Previously I would have made three phone calls for each patient not on our system,” Dr. Griffith says. “And I still wouldn’t have the imaging, so I’d have to delay my report. If the patient was going back to the clinic that same day, they wouldn’t have the report for their clinic appointment. Their care could not be completed in that episode.”
“That one delayed report may have knock on effect for several different people, all of which has time implications and patient care implications. It’s all about getting access to the right imaging to produce the right report at the right time.”
As imaging can be accessed from any site, resources can also be planned more effectively across the consortium and spare capacity on scanners can be better utilised.
Sectra PACS is a web based solution which removes potential bottlenecks on specific workstations. All users have a roaming profile which means they have access to their customised view from any workstation, anywhere.
Getting the necessary information where it needs to be is exactly what Sectra PACS does.
The ability to access images from other hospitals in the consortium has never been so simple. Clinicians simply search or select any patient from the relevant worklist enabling them to see the full patient record instantly. As a scalable, future proof system which is fully XDS compliant clinicians will soon be able to carry out a system wide search across multiple Trusts including private hospitals outside of the SWASH domain.
“Patient flow is the primary goal, to make the patient pathway as seamless as possible, with the best utilisation of resources,” says Dr Griffiths. “We should not be repeating imaging or wasting clinicians’ and patients’ time. If the patient has imaging in the independent sector, then we should be using that data. It is madness for us to be repeating it.”
Using Sectra web viewer, clinicians for the first time have full access to the same tools as radiologists for advanced manipulation and interrogation of imaging using the Sectra Volume Visualisation package. They can also customise how they view imaging.
“They can visualise abnormalities or rotate a hip fracture in three dimensions,” says Dr Griffiths. “This helps them visualise what is going on, rather than having to find a radiologist. They can do it on their own computer with the patient in front of them.”
Sectra PACS supports teleradiology to facilitate home working and is complemented by Sectra LiteView—enabling the user to safely and securely access images and information regardless of location.
The practical implications of mobile working are very significant, explains Dr Griffiths: “We put a lot on the ability to review images offsite. If a senior clinician is at home they can support our juniors and do their reporting from home. The radiologist, the neurosurgeon, the orthopaedic surgeon, the trauma surgeon can all provide support from home.”
“We can have a neurosurgeon from Southampton, giving advice on a scan in the Isle of Wight from his own home. A while ago, that would have meant a taxi to the airport, a flight and a great deal of time. Now we are moving the data, not the people.”
The effectiveness and efficiency of multi-disciplinary (MDTs) teams is another dramatic improvement, says Dr Griffiths. MDTs now have access to imaging from a whole region, and from a full range of specialities, providing a much better picture of what is happening to the patient as well as helping clinicians to explain changes in a patient’s imaging. Time is being saved by using the inherent Sectra MDT package to easily prepare MDT meetings with patient worklists.
With so many benefits for clinicians, radiologists and most importantly the patient, this really is a new era in PACS, says Dr Griffiths. “It is hard to imagine not having this now. And that is where technology is good, it makes everything simpler and easier. People use it intuitively to improve patient care.”
Portsmouth NHS Trust has seen a huge reduction in incoming calls from Southampton, where staff previously requested images over the phone. “Real-time viewing has made a massive difference clinically,” he says. “Clinicians have given highly positive feedback on new customisable views, they are positive about customisable work lists, and they are particularly pleased with access to the inherent 3D tools directly from their PC.”
Sectra PACS has also benefited the PACS administration team at Portsmouth NHS Trust. PACS administrators now have far more user friendly system admin tools, with drag and drop facilities that allow them to quickly correct instances of imaging being placed in the wrong folder.
Another additional benefit is the flexibility within Sectra PACS. You are able to set different session time-out lengths for different user groups, meaning that the system can remain logged in during periods of inactivity for varying amounts of time, depending on where it is being used in the hospital.
“We can now group all theatre PCs into one computer group with a four hour time-out, whilst ward PCs are allocated to a 15 minute time-out group.”
Sectra’s project organisation includes roles for the customer and Sectra employees. The organisation is designed to ensure close collaboration between Sectra and the customer,which has been key to success in the SWASH deployment.
PACS manager Mark Gardner says: “We were impressed with the amount of senior representatives from Sectra who have taken part in the process. The right people have been there both before and after the procurement. We still work closely with same people that have been involved in the procurement.”
Clinical lead Dr Mark Griffths says: “We saw in Sectra a company that would work with us to continually improve their own product and help us to improve the service we provide to our patients by taking on board what we needed from them.”
