Consultant Radiographer Practice in GI Fluoroscopy

Consultant Radiographer Practice in GI Fluoroscopy.

Robert Law Frenchay Hospital - Bristol GIRSIG 2004 The Pressures on Radiology.

• Shortage of radiologists • Waiting list • Timely/accurate reports • Multi-modality cover • Devolve lists to others Devolvement of Examinations to Radiographers:

• Loss of variety • Reporting machine • Deskilling • Loss of multi-modality competence • Loss of Competence for the Complex • Private practice • Out of hours service Radiologist Sub-specialization

GI. Neuro. Cardio. Musculo Vascular. GU -thoracic. -skeletal

….. Boundary Issues …..

Plain films - Fluoro – CT – MR – US – NM -Angios

Advanced Practice Radiographer What has the Radiologist got the Radiographer hasn’t?

- Medical qualifications/experience - Indemnity - Knowledge of a wide range of differential diagnoses associated with all aspects of anatomy & physiology - Multi-modality advanced practice - Control The Difference between Advanced Practice Radiographers & Radiologist. • Radiologists: Clinical expert with technical knowledge • Radiographer: Technical expert with clinical knowledge Vive la difference What has the Radiologist got the Clinical Radiographer in Advanced Practice hasn’t?

- Multi-modality advanced practice - Knowledge of a wide range of differential diagnoses associated with all aspects of anatomy & physiology - Medical qualifications/experience - Indemnity - Control What has the Radiologist got the Consultant Radiographer hasn’t?

• 1970. Qualified • 1974. Radiographer Frenchay • 1980. Superintendent 3, General X-ray department • 1992. Sidestep to Clinical Radiographer (Supt. 3) • 2001. District Supt. 1. Clinical Specialist

• 2003. Appointed Consultant Radiographer TIME LINE • Feb 01 – Article ?AHP Consultants by 01.04.01 • Feb 01 – Identified the need for Consultant lead in G.I. Fluoroscopy • June 01 – Outline bid and job description to Regional Nursing Officer for feedback • Dec 02 – Updated drafts to Dir. Of Nursing for comment • June 03 – Proposal sent for official approval • Nov 03 – Post advertised • Dec 03 – Interviews and appointment • Jan 04 – Consultant Radiographer in post AHP Consultant Appointment:

• In House appointment - Department and senior clinical staff aware of role extension - No need to ‘hit the ground running’ Scheduling; ‘No longer able to ‘fly by the seat of my pants’.

Fluoroscopy Reporting Advising Communicating In house teaching University commitments Admin Joint medical-surgical meetings CRC – MDT meetings None clinical meetings Research and audit Appraisal Radiology pressures Maintaining low waiting list Timely/accurate reports Shortage of radiologists Multi-modality cover Devolve lists to others Consultant - Radiographer Pressures. • Maintaining a low waiting list • Timely/accurate Reports • Fluoroscopy cover • Shortage of staff • Devolving lists to others Career progression in GI Fluoroscopy.

Con Rad. AP level 3 A P level 2 AP level 1 Trainee in GI fluoroscopy Qualified radiographer Trainee in GI fluoroscopy:

IV injection training NG Intubation DCBE: Practical Technique, Technique problem solving Tutorials: Anatomy Pathology Reporting sessions Competency, Advanced practitioner level 1:

• DCBE • Ng intubations. • Peripheral veinography. • Tick box reporting. Competency advanced practitioner level 2:

• Problematic DCBE • Barium swallows • Learning Small bowel enteroclysis • DCBE definitive reporting competence gained within double reporting protocol • - normal and uncomplicated D.D. • Written reports on all abnormal examinations Competency, advanced practitioner level 3:

• Definitive reports within a double reporting protocol • Extend ability to undertake a wide range of examinations • Act as mentor and provide advice to trainees and clinical radiographers • Provide day to day cover in the absence of the consultant radiographer - liasing with GPs clinicians and patients • Vet and arrange appointments as appropriate Clinical area of responsibility and medical practitioner involvement. Not required Problematic FB intubation.* Jejunostomy tube replacement.* DC Barium Enema.**/*** Ileus; flatus tube insertion.* Gastrograffin enema.**/*** ‘T’ tube chole.*** Barium swallow/meal.*** Immediately available SB Enteroclysis.**/*** MCUG/cystograms.*** Colostomy enema.**/*** Peripheral venography*** Screening of diaphragm.* NG tube/wire insertion prior to SB enema. *** OS stent placement. * Post OS Ba swallow.**/*** Abscess drain insertion*** Colonic transit studies.* Radiographer Reporting; Fistulograms.*** (*) Single reporting In communication (**) Double reporting. Non-ionic upper GI exams. *** (***) D/W with radiologist Radiologists as Colleagues.

- Close and mutually supportive relationship - A Second opinion - Medical practitioner support –(ie IV contrast) - Working together on aspects of intervention where Trust indemnity is not available -Work together Clinical decision making;

Significant pathology;

GP - Advise Patient - Explain Follow-up - Arrange Referral letter - Inform Examination - Review with clinician