NHS Cornwall and Isles of Scilly integrated care system (ICS) introduced a pioneering X-ray car service to help drive the left shift from hospital to community. Kathy Oxtoby reports as part of Healthcare Leader’s focus on this area of work
The X-ray car is a collaboration between NHS Cornwall and Isles of Scilly Integrated Care Board (ICB), local GPs, Royal Cornwall Hospitals NHS Trust and Kernow Health CIC.
This service, introduced last year, ‘plays a valuable role in shifting the delivery of care from hospital into the community in line with the NHS Long Term Plan’, says Juliet Ferris, place director for the West Integrated Care Area for NHS Cornwall and Isles of Scilly ICB.
In Cornwall, more than 1,000 frail and older people are conveyed to the emergency department (ED) each year following a fall, usually by ambulance, where an X-ray then confirms no fracture.
‘By taking the X-ray to the person we could: reduce unnecessary ambulance conveyances, releasing more ambulances to respond to 999 calls; avoid ED attendances and reduce admissions including additional further tests; reduce in-patient stays (on average 2/3 days) and complex discharge arrangements,’ Ms Ferris says.
The X-ray car is staffed by a team of two who are equipped with an ultra-portable, low dose X-ray machine about the size of a large camera. This can be easily transported in order to safely and effectively X-ray people in their own homes. The resulting digital image is securely sent back to the radiology team at the Royal Cornwall Hospital, giving the patient a result within minutes. This often rules out a broken bone, leaving a comparatively simple medical problem that can be supported in the community.
‘Overall, this brings notable benefits for everyone involved: the patient, the ambulance service, and the hospital trust,’ Ms Ferris says.
The ICB convened weekly cross organisational meetings to engage and involve people in a collaborative design of how the service would work best, solving problems together and working to a common aim.
The hospital’s imaging department was an integral part of this, and group membership evolved in response to recognition of expertise needed. Metrics and a dashboard were devised by the group, accessible by all members for review on a weekly basis to understand activity changes.
The X-ray car team saw 618 people in a year with visits completed on average in just 42 minutes. Some 535 of those (almost 9 in 10) avoided a trip to the ED, which in many cases would have otherwise been by ambulance, and were able to stay at home and be supported by services in the community.
More than 50% of referrals came from primary care. Patients and their loved ones have welcomed the initiative. They are impressed with the efficiency, and the professionalism and understanding of the team. One described it as ‘better than winning the lottery’.
Consultant radiographer, Chrissie Eade from Royal Cornwall Hospitals NHS Trust says: ‘Many of the people we see are delighted to be able to stay at home. We know that frail older people quickly lose their confidence and independence in hospital, so we try to keep people at home where it is safe to do so.’
‘By its very nature, every innovation means breaking new ground. Inevitably there were some challenges to overcome, in this case primarily linked to the use of new technology which is mobile,’ Ms Ferris says. ‘Having a shared aim has been key in finding resolutions, recognising the benefits for people and the healthcare system whilst balancing safety and quality of care.’
The mobile X-ray service was originally launched in the West Integrated Care Area of Cornwall, and has since expanded to reach more people across the county.
Dr Matt Whiteley, clinical director for the service and a GP partner at a local practice, helped to launch the service. ‘We are incredibly proud of this pioneering project,’ he says. ‘Each year in Cornwall roughly 1,000 patients aged over 50 have a fall. Many are taken to the emergency department by ambulance. In just a year we have significantly reduced that number.’
A number of other regions around the country are now looking to implement their own X-ray cars. The ICB says the success of this project locally has also prompted consideration regarding ‘what else can be done to bring the level of care traditionally seen in a hospital into the community setting, where patients are much happier and often have better outcomes’.
A short film on the X-ray car featuring Dr Matt Whiteley, clinical director for the service and GP partner, is available here.
