Taking acute medical imaging to the patient, the domiciliary based X-ray response team

Abstract

Objectives In 2019 NHS England and NHS Improvement announced their strategy to safely reduce the number of patients who are unnecessarily conveyed into a hospital setting by 2023. The recent coronavirus pandemic emphasised the importance of reducing avoidable conveyance. Consequently, a multidisciplinary team consisting of a Paramedic, Radiographer and Emergency Care Clinician was created to respond to Category 3 and 4 calls to assess patients in their own home using an array of specialised diagnostic equipment including a lightweight portable X-ray unit supplied by Fujifilm, the FDR Xair. This team was named the X-ray response team (XRT). Key findings Over a 7-month period the team attended 54 calls, the majority of which were in the patient's private residence (86%), the overall average age of the patients attended was 80 years. A patient survey found 100% of respondents rated the service as very good with 100% also feeling that they were treated with respect and dignity. The team reduced avoidable conveyance by 50% as 27 of the 54 patients were discharged on scene and kept at home. Conclusion Proof of concept was achieved. The XRT improved patient care and experience as patients were assessed and diagnosed in their home environment which also minimised the risk of contracting hospital acquired infections. Implications for practice The XRT reduced avoidable conveyance by 50% with 100% of the patient's involved providing positive feedback. The team are exploring new pathways that would allow direct referral to specialist teams in the hospital such as care of the elderly and orthopaedics which would: improve patient experience, ease A&E pressures, reduce costs and make the most effective use of the resources available.

The Response of Hospital at Home Services During the Covid-19 Pandemic: A Scoping Review

“…43 Mark et al describe a new service to avoid attendances to the emergency department, the development of a mobile X-ray unit. 40 The service for older people following suspected fractures ensures that only those with confirmed fractures on X-ray are admitted while others remain at home. Kadafa et al demonstrate how HAH’s robust infection control measures resulted in no acquired Covid-19 cases on their service by either a patient or healthcare worker.…”

“…43 Mark et al describe a new service to avoid attendances to the emergency department, the development of a mobile X-ray unit. 40 The service for older people following suspected fractures…”

Reimagining Radiology: A Comprehensive Overview of Reviews at the Intersection of Mobile and Domiciliary Radiology over the Last Five Years

“…However, the nuanced variations in opinions on different examinations underscore the intricate challenges associated with integrating domiciliary radiology into routine healthcare practices [ 2 ]. In recent times, Mark et al’s (2022) [ 3 ] establishment of a domiciliary-based X-ray response team marks a practical advancement. This initiative not only garnered positive feedback from patients but also demonstrated a substantial reduction in avoidable conveyance, offering a promising avenue for improving patient care and experiences.…”

“…The ongoing discourse about its merits and challenges is a testament to the dynamic equilibrium it seeks to establish. The true crucible of domiciliary radiology, including the pivotal role of mobile radiology units, emerged during the COVID-19 pandemic [ 3 ]. Crafted to cater to unique patient needs, this practice became an indispensable lifeline, especially for individuals with fragilities and disabilities.…”

Beyond the Clinic Walls: Examining Radiology Technicians’ Experiences in Home-Based Radiography

“…Within the transformative realm of domiciliary radiology, illuminated by the exhaustive scoping review led by Toppemberg et al [1], a profound shift in healthcare delivery is discernible. Spanning from the pioneering initiatives of Losev in 1958 [2] to contemporary endeavors exemplified by Mark et al's establishment of a domiciliary-based X-ray response team in 2022 [3], a palpable evolution toward a patient-centric ethos in radiological practices unfolds. While an array of studies illuminates promising outcomes, encompassing noteworthy Healthcare 2024, 12, 732 2 of 17 cost-effectiveness [4], intricate operational dynamics [5], and a resounding positive reception from patients [6], a compelling necessity emerges for a meticulous exploration into the experiential landscape of professionals within this dynamically evolving field.…”