Patient safety and image transfer between referring hospitals and neuroscience centres: could we do better?

Abstract

Introduction. District general hospital scanners have historically been linked to regional neuroscience units for specialist opinions on scans and to make decisions on transfer of patients requiring neurosurgical management. The implementation of digital picture archiving and communication systems (PACS) in all hospitals in the UK has disrupted these dedicated links and technical and information governance issues have delayed reprovision of electronic transfer of images for rapid expert decision making in this group of patients. We studied improvement in image transfer to acute neurosurgery units over a 4-year period.

Methods. Four-year sequential review of national provision of image transfer facilities into neurosurgery units; observational study of delays associated with image transfer modalities in one representative tertiary referral centre.

Results. During the 4 years of study, all hospitals nationally have implemeted digital PACS systems for image viewing. Remote image viewing facilities have gradually changed with dedicated image links being replaced by remote PACS access. However, a minority of referrals (12%) still require images to be physically transferred between hospitals using couriers for CD-ROMs. The detailed study within our own unit shows that this adds a mean delay of 5.8 h to decision making.

Conclusions. Image transfer in neuroscience has been neglected following the shift to PACS servers. The recommendations of the 2004 Neuroscience Critical Care Report are unmet and patient safety is being threatened by a continued failure to implement a coordinated solution to this problem.

Key words:

• Imaging
• teleradiology
• image transfer
• NHS connecting for health

Acknowledgements

M.C. collected data from 2009 and designed, wrote and revised the manuscript. W.C.-A. and S.P. reviewed and revised the manuscript, and collected the data from 2005 with assistance of Mary Murphy (The Royal Free Hospital Neurosurgical Unit). T.L.J. reviewed the manuscript and together with J.A. collected and analysed data from 2009. B.A.B. conceived and supervised the study from inception and has critically reviewed and revised the manuscript. The authors declare that they have no competing interests. Matthew Crocker is funded by the Neurosciences Research Foundation and the London Deanery and Timothy Jones is funded by the Neurosciences Research Foundation.