title: Reducing imaging waiting times: enhanced roles and service-redesign.
abstract: OBJECTIVE
  The aim of this paper is to explain how University Hospitals of Leicester's Nuclear Medicine service managers needed to reduce waiting times to comply with internal clinical requirements and with external local primary care trust (PCT) and national Department of Health targets.
  
  
  METHODS
  The team undertook a comprehensive service review to identify problem areas and potential improvements, including: process mapping; data gathering (activity and demand, equipment and staff availability/utilisation); external practice reviews, searching evidence bases; and financial implications. This case study describes how an inter-disciplinary team redesigned the service and used new working methods to reduce waiting times. Their aim was to discuss a service's practical elements and show how innovation leading to sustainable change can be implemented effectively.
  
  
  RESULTS
  The review highlighted service delivery bottlenecks for myocardial perfusion imaging, which were linked to medical staff shortages, staff use and equipment between hospital sites, and a silo approach to referrals rather than a coordinated organisation-wide approach.
  
  
  CONCLUSIONS
  Introducing enhanced roles allowed nurses, radiographers and technologists to undertake work previously performed by medical staff thus removing a key service bottleneck. Modifications to service delivery and a cultural change in nuclear medicine resulted in a service that was more efficient, flexible and able to cope with increased demand.
  
  
  CONCLUSIONS
  These changes meant that minimum waiting-time targets were achieved, in particular waiting for myocardial perfusion imaging (reduced from 42 weeks in 2005 to two weeks by 2009). Changes allowed service managers to maintain short waiting times in the current, challenging healthcare climate.
authors.affiliation: Department of Medical Physics, University Hospitals of Leicester, Leicester, UK. Claire.greaves@uhl-tr.nhs.uk
authors.forename: Claire
authors.initials: C
authors.lastname: Greaves
authors.forename: Judy
authors.initials: J
authors.lastname: Gilmore
authors.forename: Lizelle
authors.initials: L
authors.lastname: Bernhardt
authors.forename: Lisa
authors.initials: L
authors.lastname: Ross
mesh_terms: D017598:Efficiency, Organizational; D006801:Humans; D055414:Myocardial Perfusion Imaging / Q000706:statistics & numerical data*; D009684:Nuclear Medicine Department, Hospital / Q000458:organization & administration*; D019982:Organizational Case Studies; D010348:Patient Care Team / Q000458:organization & administration; D017064:Process Assessment, Health Care; D024382:Professional Role; D058996:Quality Improvement / Q000458:organization & administration*; D013647:Task Performance and Analysis; D006113:United Kingdom; D014850:Waiting Lists