An economic evaluation of introducing a skills mix approach to CT head reporting in clinical practice

• There was 5.2 million CT scans from April 2013 to March 2014 in the UK.
• In 2015 the RCR estimated there were up to 3693 unreported CT scans.
• Comparison of workforce, reference standards, unit costs and risk.
• The use radiographers to report CT heads has a potential for cost savings.

BackgroundComputed Tomography (CT) head examinations are a common diagnostic examination in National Health Service (NHS) acute hospital trusts. Current NHS England and Royal College of Radiologist (RCR) reports estimate the year on year increase of examinations to be 10%, with the designated workforce of radiologists disproportionate to the increase in demand of imaging reporting.ObjectiveTo determine an economic evaluation of cost, risk and feasibility of introducing skills mix CT head reporting by radiographers.DesignApplying a PICO framework study to evaluate the patient workflow demand from retrospective audit data of CT head examination attendance (n = 7266) at an acute NHS district general hospital (DGH) to model an example workflow demand over 12 months. Reviewing potential outcome risk data (diagnostic thresholds), and feasibility (workforce capacity) of both interventions. The economic evaluation calculated hourly unit costs for comparison estimation of consultant radiologists and reporting radiographers using Netten et al.'s Ready Reckoner. Report unit costs were calculated utilising the Gishen's Ready Reckoner to estimate the uninterrupted time of reporting a non-complex CT report using RCR, Centre for Workforce Intelligence (CfWI) and Department of Health (DoH) estimates for both interventions.ConclusionsThe economic evaluation of introducing a skills mix reporting service model to the benefit of service delivery with the NHS has shown a potential £299,359–£124,514 per annum cost saving using a generic acute DGH workload model. Research into recorded discrepancy/error audit data for potential detrimental risk to patient outcomes identified a paucity of evidence, and recommends further research is needed.