54Patient centred quality care:Radiographer led brachytherapyand novel service redesignLisa Punt2010<strong>IMAGING</strong> &<strong>ONCOLOGY</strong>
Breaking down pr<strong>of</strong>essional barriers andchallenging traditional boundaries can leadto a novel and highly effective radiographerled service, ultimately putting the patient atthe very heart <strong>of</strong> quality care.IntroductionInnovation and modernisation have been high on the agenda for the Department <strong>of</strong>Health during the last decade. Publication <strong>of</strong> the NHS plan in July 2000 highlighted theneed for fi nancial investment and reform to ensure the UK had an NHS service fi t for the21st century 1 . The plan recognised the failings <strong>of</strong> an out <strong>of</strong> date operating system thatlacked equitable care, disempowered patients, up-held ‘old fashioned’ demarcationsbetween staff, and had no clear incentives or levers to improve performance 1 . It wasclearly identifi ed that, hand in hand with increased funding, new ways <strong>of</strong> working wouldbe needed if our NHS was to become a world leader in healthcare delivery.In 2000, the Department <strong>of</strong> Health published the Meeting the challenge document,which set out to identify the pivotal role allied health pr<strong>of</strong>essions would have inimplementing innovative, patient centred practice and service delivery that wouldultimately improve patient outcomes 2 . The document identifi es the government’srecommendation for the development <strong>of</strong> consultant therapist posts, with keyresponsibilities to strengthen pr<strong>of</strong>essional leadership whilst influencing serviceimprovement.This article describes how successful service redesign, in the form <strong>of</strong> a radiographerled vaginal vault brachytherapy service, has been implemented by a consultantradiographer. Through novel ways <strong>of</strong> working, skill-mixing and breaking downtraditionally held pr<strong>of</strong>essional boundaries there has been greater patient throughput,better equipment utilisation, improved patient continuity and improved quality <strong>of</strong> care.Other factors required for the success <strong>of</strong> this service included advanced clinical skills,strong leadership skills, and a clear service need.The fi rst UK radiographer led new patient clinic for adjuvant pelvic radiotherapy inendometrial cancer is now well established. However, a continued focus on serviceneed, training and service delivery, and audit is required if the service is to besustainable. Results <strong>of</strong> a recent evaluation audit <strong>of</strong> this service will be discussed.Radiographer led Vaginal Vault Brachytherapy (BT) service:BackgroundVaginal vault BT is predominantly used in the adjuvant setting for treatment <strong>of</strong>endometrial cancer 3 . It may be used in conjunction with external beam radiotherapy,<strong>of</strong>fering a boost to the top <strong>of</strong> the vaginal vault or alone to minimise the risk <strong>of</strong> recurrencewithin the vault for those women with low-intermediate risk endometrial cancer 4 . Theplanning process involves vaginal examination to assess the capacity <strong>of</strong> the vaginafollowed by a sizing procedure, using dummy tubes, to measure the vaginal length anddiameter <strong>of</strong> treatment tube required. Historically, this procedure – together with thetreatment process, consent and follow-up – was undertaken by a clinical oncologist.Service need: new ways <strong>of</strong> working?In the early days <strong>of</strong> developing a radiographer led service for vaginal vault BT thedriving force behind role development and skill mix changes was a need to improveequipment utilisation and reduce inpatient stays. At the time, low dose rate BTequipment was in general use and the treatment procedure involved overnightadmission due to the 10-12 hour treatment times. Treatment days were limited to thetwo days when oncologists were available to plan and deliver the BT, thus limiting thepatient throughput and increasing waiting times. In order to optimise treatment it wasclear that with novel and cross boundary working there was a potential to increasepatient throughput and reshape service delivery.Following initial consultation with the local lead clinical oncologist, a competencyprogramme was designed, to evidence expert practice and role development in thisfi eld <strong>of</strong> practice. The clinical education programme included patient consent, vaginalexamination, brachytherapy procedure and on-treatment review.With novel and crossboundary working therewas potential to increasepatient throughputTraining was undertaken with the supervision <strong>of</strong> the local clinical oncologist whilstacademic learning was evidenced through a work-based module in gynaecologicaloncology. This module was supported by the multi-pr<strong>of</strong>essional team withingynaecological oncology and accredited by Sheffi eld Hallam University. Partnershipwith higher educational institutions provides essential support in developing workbasedor role dependent education programmes and through a portfolio <strong>of</strong> evidenceis able to demonstrate breadth and depth <strong>of</strong> learning. Refl ective practice is also a keyskill associated with high levels <strong>of</strong> clinical reasoning and autonomous practice 5 .With training complete, the entire treatment pathway from consent through todischarge is now undertaken by a radiographer (Figure 1).552010<strong>IMAGING</strong> &<strong>ONCOLOGY</strong>