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Clinical-scientist-led transoesophageal echocardiography (TOE): using extended roles to improve the service
At the North West Anglia NHS Foundation Trust, we perform transoesophageal echocardiography (TOE), a semi-invasive diagnostic test using ultrasound for high-quality heart imaging. TOE allows accurate diagnosis of serious heart problems to support high-quality clinical decision-making about treatment...
Autores principales: | , , , , |
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Formato: | Online Artículo Texto |
Lenguaje: | English |
Publicado: |
BMJ Publishing Group
2023
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Materias: | |
Acceso en línea: | https://www.ncbi.nlm.nih.gov/pmc/articles/PMC10533795/ https://www.ncbi.nlm.nih.gov/pubmed/37748819 http://dx.doi.org/10.1136/bmjoq-2023-002268 |
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author | Kaye, Nikki Purdon, Michael Schofield, Rebecca Antonacci, Grazia Proudlove, Nathan |
author_facet | Kaye, Nikki Purdon, Michael Schofield, Rebecca Antonacci, Grazia Proudlove, Nathan |
author_sort | Kaye, Nikki |
collection | PubMed |
description | At the North West Anglia NHS Foundation Trust, we perform transoesophageal echocardiography (TOE), a semi-invasive diagnostic test using ultrasound for high-quality heart imaging. TOE allows accurate diagnosis of serious heart problems to support high-quality clinical decision-making about treatment pathways. The procedure can be lengthy and is traditionally performed by a consultant cardiologist, who typically has multiple commitments. This constrains patient access to TOE, leading to waits from referral to test, delaying treatment decisions. In this quality improvement project, we improved access by redesigning workforce roles. The clinical scientist, who had been supporting the consultant during TOE clinics, took on performing the procedure as the main operator. We used the Model for Improvement to develop this clinical-scientist-led service-delivery model, and then test and refine it. This increased capacity and frequency of TOE clinics, reducing waits and releasing around 2 days per month of consultant time. Over five plan-do-study-act cycles, we tested six changes/refinements. Our targets were to reduce the maximum waiting time for TOE to 3 working days for inpatients and to 14 working days for outpatients. We succeeded, achieving reductions in mean waiting times from 7.7 days to 3.0 days for inpatients and from 33.2 days to 8.3 days for outpatients. TOE requires intubation; when this fails, TOE is abandoned. We believe light (rather than heavy) sedation is helpful for this intubation. We reduced sedation levels (from a median of 3 mg of midazolam to 1.5 mg) and, as a secondary outcome of this project, reduced the intubation failure rate from 13% to 0% (over 32 postchange patients). Following this project, our TOE service is usually performed by a clinical scientist in echocardiography who has British Society of Echocardiography TOE accreditation and advanced training. We have sustained the improved performance and demonstrated the value of enhanced roles for clinical scientists. |
format | Online Article Text |
id | pubmed-10533795 |
institution | National Center for Biotechnology Information |
language | English |
publishDate | 2023 |
publisher | BMJ Publishing Group |
record_format | MEDLINE/PubMed |
spelling | pubmed-105337952023-09-29 Clinical-scientist-led transoesophageal echocardiography (TOE): using extended roles to improve the service Kaye, Nikki Purdon, Michael Schofield, Rebecca Antonacci, Grazia Proudlove, Nathan BMJ Open Qual Quality Improvement Report At the North West Anglia NHS Foundation Trust, we perform transoesophageal echocardiography (TOE), a semi-invasive diagnostic test using ultrasound for high-quality heart imaging. TOE allows accurate diagnosis of serious heart problems to support high-quality clinical decision-making about treatment pathways. The procedure can be lengthy and is traditionally performed by a consultant cardiologist, who typically has multiple commitments. This constrains patient access to TOE, leading to waits from referral to test, delaying treatment decisions. In this quality improvement project, we improved access by redesigning workforce roles. The clinical scientist, who had been supporting the consultant during TOE clinics, took on performing the procedure as the main operator. We used the Model for Improvement to develop this clinical-scientist-led service-delivery model, and then test and refine it. This increased capacity and frequency of TOE clinics, reducing waits and releasing around 2 days per month of consultant time. Over five plan-do-study-act cycles, we tested six changes/refinements. Our targets were to reduce the maximum waiting time for TOE to 3 working days for inpatients and to 14 working days for outpatients. We succeeded, achieving reductions in mean waiting times from 7.7 days to 3.0 days for inpatients and from 33.2 days to 8.3 days for outpatients. TOE requires intubation; when this fails, TOE is abandoned. We believe light (rather than heavy) sedation is helpful for this intubation. We reduced sedation levels (from a median of 3 mg of midazolam to 1.5 mg) and, as a secondary outcome of this project, reduced the intubation failure rate from 13% to 0% (over 32 postchange patients). Following this project, our TOE service is usually performed by a clinical scientist in echocardiography who has British Society of Echocardiography TOE accreditation and advanced training. We have sustained the improved performance and demonstrated the value of enhanced roles for clinical scientists. BMJ Publishing Group 2023-09-25 /pmc/articles/PMC10533795/ /pubmed/37748819 http://dx.doi.org/10.1136/bmjoq-2023-002268 Text en © Author(s) (or their employer(s)) 2023. Re-use permitted under CC BY. Published by BMJ. https://creativecommons.org/licenses/by/4.0/This is an open access article distributed in accordance with the Creative Commons Attribution 4.0 Unported (CC BY 4.0) license, which permits others to copy, redistribute, remix, transform and build upon this work for any purpose, provided the original work is properly cited, a link to the licence is given, and indication of whether changes were made. See: https://creativecommons.org/licenses/by/4.0/. |
spellingShingle | Quality Improvement Report Kaye, Nikki Purdon, Michael Schofield, Rebecca Antonacci, Grazia Proudlove, Nathan Clinical-scientist-led transoesophageal echocardiography (TOE): using extended roles to improve the service |
title | Clinical-scientist-led transoesophageal echocardiography (TOE): using extended roles to improve the service |
title_full | Clinical-scientist-led transoesophageal echocardiography (TOE): using extended roles to improve the service |
title_fullStr | Clinical-scientist-led transoesophageal echocardiography (TOE): using extended roles to improve the service |
title_full_unstemmed | Clinical-scientist-led transoesophageal echocardiography (TOE): using extended roles to improve the service |
title_short | Clinical-scientist-led transoesophageal echocardiography (TOE): using extended roles to improve the service |
title_sort | clinical-scientist-led transoesophageal echocardiography (toe): using extended roles to improve the service |
topic | Quality Improvement Report |
url | https://www.ncbi.nlm.nih.gov/pmc/articles/PMC10533795/ https://www.ncbi.nlm.nih.gov/pubmed/37748819 http://dx.doi.org/10.1136/bmjoq-2023-002268 |
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