An exploratory study of radiographer's perceptions of radiographer commenting on musculo-skeletal trauma images in rural community based hospitals

doi:10.1016/j.radi.2012.12.002

Radiography

Volume 19, Issue 2, May 2013, Pages 137-141

https://doi.org/10.1016/j.radi.2012.12.002 Get rights and content

Abstract

Aim

This study sought to explore the perceptions of community hospital based radiographers in North East Scotland regarding the practice of radiographer commenting on musculo-skeletal trauma images.

Method

A purposive sample of radiographers (n = 8) were recruited from community hospitals throughout the North-east of Scotland. A qualitative, exploratory study was conducted employing semi-structured interviews consisting of one focus group and two individual interviews. The interviews were audio recorded and transcribed in full to allow thematic analysis of the data using a framework adapted from Pope and Mays (2006).

Main findings

This study revealed that the practice of radiographer commenting in the community provides a valuable front line opinion on musculo-skeletal trauma image appearances to enhance diagnostic outcomes for patients and streamline their care pathway. The appreciation shown from inter-professional colleagues for this practice induced feelings of professional pride and job satisfaction in the sample group. All participants expressed a desire to undertake additional training to allow progression from radiographer commenting to radiographer reporting of musculo-skeletal trauma images.

Perceived barriers to the practice of radiographer commenting were time constraints and a lack of support with regards to continuing professional development (CPD) opportunities and mentorship from radiology colleagues.

Conclusion

The practice of radiographer commenting in the community setting should be supported by ongoing training, and radiologist involvement in mentoring could provide radiographers with a valuable support mechanism. The voice of all radiographers regarding this extended role must be heard by professional leaders to ensure that the skills and education required for radiographer commenting are provided and subsequent patient care is not compromised.

Introduction

In response to government initiatives to improve service provision in the National Health Service (NHS) healthcare setting¹ the College of Radiographers (CoR)² advocated that by 2010 all radiographers have the ability to provide an opinion on image appearances. The expectation was that this initial interpretation would consist of a written comment to replace ambiguous radiographer abnormality detection schemes (RADS) such as the red dot system.³ It was perceived that indicating the actual nature of the abnormality, as opposed to simply highlighting it by using a red dot, could provide a more timely diagnosis for patients.⁴

Although this extended scope of practice potentially offers enhanced professional status for radiographers it could be suggested that not all of the radiography profession are motivated to embrace such role extension. Furthermore any lack of resources to support this development could be detrimental to the implementation of radiographer commenting nationwide.

Radiographer commenting would appear to offer the prospect of benefiting the NHS particularly in Scotland with its many remote and rural hospitals where radiological support is often limited. Furthermore, Scottish Government initiatives towards shifting the balance of care from the acute sector to the community setting strongly advocate better use of non-medical skills in the community to lead to measurable improvements in patient outcomes.⁵

Current practice of RADS within a trauma setting in the UK was assessed by Snaith and Hardy⁴ using a questionnaire. This study revealed that smaller hospitals with minor injury units (MIUs) were less likely to use RADS than a larger centre with an emergency department (ED).⁴ In addition, they propose that due to the lack of available medical expertise in the community, patients attending smaller casualty departments or (MIUs) could benefit more from a radiographer's opinion than those attending an ED.

Significantly, Snaith and Hardy found that only 10% of the 30 Scottish departments that responded operate a radiographer commenting scheme. The reasons surrounding this poor participation in Scotland in 2007 is unknown. However in the current climate, the number of departments undertaking commenting could possibly be higher. Nevertheless further evaluation of commenting schemes using qualitative methods would allow exploration of the issues from the perspectives of the radiographers involved.⁶

A recent qualitative study in one English Trust investigating the opportunities and barriers to participation in a radiographer commenting scheme found that resistance existed in terms of commenting being a formal, compulsory practice.⁷ Some 83.1% (44/53) of respondents to the questionnaire believed that commenting should not be compulsory. Personal confidence, medio-legal status and time constraints were stated as potential reasons behind this significant resistance to initial commenting. Although this finding could be regional, clearly more research is needed to explore the reasons behind radiographers' reticence to formally adopt the role of commenting.

The key research focussed on the topic of radiographer commenting was undertaken by Hardy and Culpan³ who adopted a pre-test, post-test approach involving participants being tested both at the start and at the end of a red dot training course. It should be noted that attendees at this course did not receive specific training on how to formulate a comment and therefore it could be argued that the intervention was invalid to fully fulfil the aims of the study.

One hundred and twenty radiographers were assessed on their ability to recognise (red dot) and describe (comment) in a non-clinical environment. This environment could perhaps be considered sub-optimal as the participants were removed from their ‘real life’ working surroundings. It could be argued that radiographers would perform differently in the hospital setting and undertake the task of initial commenting in collaboration with colleagues and correlation with the patients' clinical presentation.

Their findings identified that although radiographers can provide a first line radiographic interpretation, doubt is cast over their ability to provide an accurate written comment describing the image. These conclusions arise from significant differences between mean ‘red dot’ and commenting scores with pre-test mean radiographer commenting being 13.7% less than mean ‘red dot’ scores and post-test mean commenting scores being 10.8% less. Training appeared to have a positive effect on the post-test mean scores with red dot improving by 9.8% (p = 0.012) and commenting by 12.7% (p = 0.007).

Despite the limitations of this study there is evidence to suggest there is a requirement to train radiographers in the practice of written commenting prior to widespread implementation. Furthermore, it would seem a robust evidence base to support this practice is essential as potentially patients' welfare could be compromised.

To date, little research has been undertaken exploring the practice of radiographer commenting and no studies focus specifically on community hospitals. Given the pressure from government and professional bodies for all radiographers to embrace this role development and the potential benefits to service provision, particularly in the community, examination of the issues is needed. Furthermore, following an extensive literature search it was found that the perceptions of community based radiographers regarding this extended role is unexplored territory.

The aim of this research was to explore the perceptions of community hospital based radiographers in rural Aberdeenshire regarding the practice of radiographer commenting on musculo-skeletal trauma images. The objectives of the study were as follows;

•
To investigate the perceptions of community based radiographers on the development of radiographer commenting in community radiology facilities in the North Aberdeenshire area of NHS Grampian.
•
To establish community radiographers' perceptions of the drivers and barriers to commenting in the community setting.
•
To identify community radiographers' views regarding training needs for the practice of radiographer commenting on musculo-skeletal trauma images

Section snippets

Methods

A qualitative line of inquiry was used to reveal participants' experiences and their perceptions regarding what is happening⁸ with regards to commenting at the current time.

Qualitative interviewing which is referred to as the ‘gold standard’ of qualitative research⁹ was deemed the most appropriate method to elicit the views of this small population of community based radiographers.

A focus group of six participants and two individual interviews were employed in this study (n = 8). This was

Results

The findings of this study are presented in the discussion section as a series of narrative responses from the participants reflecting the conversational approach to interviews. This style of presentation is supported by the belief that narratives of radiographers' experiences can assist exploratory research and provide an evidence base for practice enhancement and professional development.¹⁸ Particular issues relating to the practice of radiographer commenting are demonstrated within these

Discussion

The content and nature of responses during the interview process led to identification of the following key themes which arose primarily from the focus group and were substantiated by the individual interviews. These themes are strongly inter-related and not mutually exclusive. They represent the main areas that the participants felt that radiographer commenting impacted upon;

•
Patient care pathway
•
Diagnostic Radiography Profession
•
Continued Professional Development (CPD) for radiographers

Conclusion

This small scale study did not set out to generalise to the wider radiography profession but rather to engage with a specific group of community hospital based radiographers in rural North East Scotland. The findings therefore could be useful to inform practice in similar remote and rural areas.

Acknowledgements

I would like to thank Dr Jennifer Caldwell for her support and advice whilst undertaking this study and I am extremely grateful to Lucy Stark for transcribing the interviews. I would also like to thank Demelza Green, Ian Henderson and Jonathan McConnell for their guidance.

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An exploratory study of radiographer's perceptions of radiographer commenting on musculo-skeletal trauma images in rural community based hospitals

Abstract

Aim

Method

Main findings

Conclusion

Introduction

Section snippets

Methods

Results

Discussion

Conclusion

Acknowledgements

Radiography

Radiography

Radiography

Radiography

The NHS plan, a plan for investment, a plan for reform

Medical image interpretation & clinical reporting by non-radiologists: the role of the radiographer

Better health, better care

Successful qualitative health research – a practical introduction

Maidenhead

Qualitative research & evaluation methods

Doing qualitative research – a practical handbook

Research methods in health

Focus groups