PETCT Mobile Services

On this page

• Overview
• Assessing needs
• Delivering evidence-based care and treatment
• How staff, teams and services work together
• Supporting people to live healthier lives
• Monitoring and improving outcomes
• Consent to care and treatment

EFFECTIVE Key Question Commentary We reviewed assessing needs, delivering evidence-based care and treatment, how staff, teams and services work together, monitoring and improving outcomes and consent to care and treatment. Assessing needs: Staff worked as part of a multidisciplinary team to ensure patients receive their scan and scan results within set timescales. Delivering evidence-based care and treatment: Staff followed policies to plan and deliver high quality care according to best practice and national guidance. How staff, teams and services work together: We saw staff working well together and with staff from their partnership organisations. Monitoring and improving outcomes: The service monitored treatment times, exposure to radiation, and worked to improve patient outcomes. Consent to care and treatment: Staff followed policy to gain patient’s consent to treatment.

This service scored 75 (out of 100) for this area. Find out what we look at when we assess this area and How we calculate these scores.

All patients were referred as urgent and were scanned, and had their scan reported on, within a 7-day timeframe. Patients could choose what day they attended their appointment. They were offered the soonest available appointment but had the opportunity to been seen on other days or times to suit them. At the point of being offered their appointment patients were asked if they had any communication or access needs.

Once the referral was received, the Administration of Radioactive Substances Advisory Committee (ARSAC) lead for the trust that the mobile unit was located at vetted referrals and justified the amount of radiation each patient would need to be exposed to, ensuring radiation doses were kept as low as reasonably practicable. Patients were weighed, had their height measured, and were asked about allergies as part of the assessment for their scan. They were asked about other scans they had had to explore how much recent radiation they had been exposed to prior to the scan.

If a communication need had been disclosed at the point of booking, the booking team would have arranged for an interpreter to be present at the appointment, and information was provided in braille for patients when required. In the first instance staff tried to arrange face-to-face interpreters to give the patient and staff confidence that the patient understood the process they were consenting to. When a face-to-face interpreter was not available the provider used telephone interpreters. The provider’s policy stated family members should not be used to interpret as staff could not be assured patients had received the correct information to enable them to give informed consent.

We did not collect enough evidence from patients about this quality statement to express their views in this report.

National and local diagnostic reference levels for CT scanners were displayed where staff could easily see them. There was a radiation awareness hazards booklet and information for visitors to read and a sheet for them to sign to say they had understood the information. Senior leaders told us that they carried out regular and ad hoc audits to capture the implementation of updates and changes in policies and protocols. Patients were provided with specific instructions relating to eating and drinking prior to their scan with their appointment letter. A text service was also used to remind patients of what they needed to do in preparation for their scan. The department had processes to audit and re audit imaging to ensure they met best practice and national guidelines.

We looked at the scanning protocols and saw they gave staff clear guidelines which contained up to date information. Staff followed policies to plan and deliver high quality care according to best practice and national guidance such as Ionising Radiation (Medical Exposure) Regulations 2017, the Royal College of Radiologists and the National Institute of Health and Care Excellence (NICE). The service had an image quality assurance process that staff understood and were using in line with protocols. The service had guidance on consent, this included the process to follow if patients lacked capacity to consent. The service had a standard operating procedure (SOP) for patients that did not attend their appointment. The SOP gave staff clear guidance to follow if patients did not attend including re-booking them for the next available appointment.

We did not collect enough evidence from patients about this quality statement to express their views in this report.

Staff told us they worked closely with their partners to provide safe care for patients. They communicated with the ARSAC at each location when they had questions or concerns about a patient. At locations where the trust also had PET-CT staff told us they did a lot of reciprocal work. For example, if a scanner had a technical problem and was temporarily out of action the provider and the trust would work together to ensure the scan went ahead the same day, especially if the patient had already been given radiotracer. The ARSACs attended their substantive trust’s multidisciplinary team meetings (MDT) to discuss treatment options following scans. They attended regular radiology events and learning meeting to review discrepancies in reporting or clinical incidents. Important findings that had learning outcomes were shared with the provider.

Partners told us the provider worked pro-actively and effectively with other health care teams Although feedback from partners was mostly positive an issue was raised about when trusts ask the provider to report on scans when this is outside of the normal commissioning arrangement. One partner felt the fact the trust and provider use different patient record systems mean it was sometimes difficult to trace the providers report which had led to delays in patient pathways. Each trust provided a reception area for patients to wait in until they could be taken to the mobile unit. Sometimes they provided a receptionist and when this was not possible a clinical assistant would adopt this role. The trust and the provider did not always use the same radiology information system (RIS) to manage patient records. One of the receptionists employed by a trust told us they had to log patients into the trust electronic record keeping system and then duplicate this information onto the provider's RIS. They told us the provider's RIS was very slow and sometimes locked them out of the system during the process.

We saw staff contact an ARSAC by telephone to confirm details of a patient’s scan. We saw an ARSAC giving staff face to face support to ensure the correct images were collected to assess treatment efficacy.

Staff had access to a local file in each mobile unit that contained the names and telephone numbers of key people in the trust they may need to contact. They also had contact details for local services, for example, adult safeguarding teams, to speed up partnership working.

Patients who were diabetic were advised to bring a meal or snacks to their appointment so they could manage their blood sugar following a period of fasting. Patients were advised to drink lots of water on the day of, and days after, their scan to speed up elimination of their radiotracer. Staff offered patients water during and after their appointment. Patients were also offered small packets of biscuits as they were leaving the mobile unit.

Patients sometimes disclosed they had not eaten for several days due to a loss of appetite linked to their oncology treatment. Staff told us they would always stress the importance of eating regular meals to patients to ensure they stayed strong and healthy.

Bottled water and small packets of biscuits were stored on the mobile units and restocked overnight as required. Staff were encouraged to offer patients bottles of water throughout their time on the unit and to stress the importance of drinking fluids over the next couple of days to speed up the elimination of radiotracer.

We did not collect enough evidence from patients in regard about statement to express their views in this report.

Staff told us they worked to improve patient access to treatment as well to improve the quality of imaging and reporting through a culture of continued learning and development. Staff participated in local clinical audits to review the effectiveness of care and treatment. Managers and staff used results to produce action plans and improve patient outcomes. The provider shared the outcomes of their audits with the local trusts and vice versa. The audits included a daily dose audit, an audit off the health and safety log, infection protection and control, hand hygiene, a peripheral vascular audit, and a Radiation Protection Supervisor audit. The provider had an audits calendar so that staff could see what audits were due to take place. However, ad hoc audits were also undertaken. Each morning staff conducted a visual inspection of the integrity of the inside and outside of the mobile unit following the Health and Safety Executive best practice guidance. An additional inspection was carried out when a mobile unit had been moved between locations. Along with a patient’s dose record if a patient had a carer or comforter with them their dose information was also recorded on the patient radiology information system (RIS).

Regular audits were undertaken to ensure staff were following up to date policies and processes. Dose audits were undertaken to ensure exposure to radiation did not go above therapeutic levels and action was taken if higher than justified levels were used. There were systems to measure the compliance with the 7-day key performance indicator. The provider gave us information to show that patients normally received their scan within 2 days of receiving their referral and the scan was normally reported on within 2 days.

Patients told us they had given written consent before their scan and that they had been given both verbal and written information about the procedure they were having to explain the risks associated with their imaging. They were also given information about their pathway up to how and when they would receive their results. The provider had patient information leaflets and information on the website about PET-CT imaging so that patients understood what was going to happen at their appointment and also about side effects of radiation so they could make an informed choice about their treatment.

Staff could explain the consent procedure to us, and all the staff we spoke to were able to tell us what steps they took if they felt a patient lack capacity to consent. This involved referring the patient back to the referring doctor to ensure a best interest decision was made involving 2 doctors and next of kin/power of attorney. The consent forms we reviewed had been completed in line with best practice. Staff explained they ensured that patients were aware of potential side effects of radiation before gaining consent. Staff were aware that they needed to give additional information to people that could be pregnant, they understood that this included checking with all patients under the age of 55 that may have been born female. The provider created a bespoke e-learning module to support staff with ongoing training needs in line with the Society of Radiographers guidance on Inclusive Pregnancy. This training supports staff to recognise and feel confident to use the preferred terminology of individuals in their care, and improve their understanding of the complexities associated with the health and care needs of people with gender diversity, and people with diversity in their physical sex characteristics.

Consent forms contained sections for patients as well as sections for staff to complete to confirm patients had been given enough information to make an informed decision about their treatment.