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The Virtual Night Hospital: Innovating Radiology Services for Enhanced Patient Care

The Virtual Night Hospital concept aims to address challenges such as the shortage of radiologists and increasing workloads by leveraging advanced technology in healthcare. By linking PACS systems and utilizing video conferencing, hospitals can facilitate real-time consultations and ensure efficient reporting of out-of-hours examinations. This virtual model reduces on-call commitments for radiologists while improving patient access to urgent care. Central Middlesex Hospital's initiative highlights the importance of innovation in meeting the complex needs of a diverse population.

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The Virtual Night Hospital: Innovating Radiology Services for Enhanced Patient Care

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  1. The Virtual Night Hospital Dr Philip Shorvon Central Middlesex Hospital London

  2. FACTORSPROFESSIONAL • SHORTAGE RADIOLOGISTS • INCREASING WORKLOAD • HEAVY CONSULTANT ON- ALL COMMITMENT PARTICULARLY IN NON-TEACHING HOSPITALS • INCREASING COMPLEXITY OF WORK • LESS EXPERIENCE OF JUNIOR CONSULTANTS

  3. FACTORSORGANISATIONAL • NETWORKED SERVICES- ORTHOPAEDICS/ NEUROSCIENCES/ VASCULAR /ONCOLOGY • EUROPEAN WORKING TIME DIRECTIVE • NIGHT HOSPITAL • ‘SMALL DGH’ MODEL

  4. FACTORS IMAGING AND IT • INCREASING USE OF IMAGING OUT OF HOURS FOR TRIAGE • NICE GUIDELINES FOR HEAD CT • INCREASE USE OF EMERGENCY CT IN ABDOMINAL AND CHEST CONDITIONS • RAPID INCREASE IN PACS SYSTEMS • IT ADVANCES ( NHS NET/BROADBAND ETC)

  5. NIGHT HOSPITAL CONCEPT • INCREASING USE OF EXTENDED ROLES • REDUCED NUMBER OF MEDICAL PERSONNEL ON SITE • MORE CONSULTANT LED SERVICES

  6. CENTRAL MIDDLESEX HOSPITAL • Innovation to survive • 2nd hospital to get trust status • Lead patient focussed concept • One of first PFI type deals for MRI (1993) • First DTC to be built (ACAD in 1999) • New build underway (BECaD) • Now merged with Northwick Park Hospital (NorthWest London Hospitals NHS Trust)

  7. CENTRAL MIDDLESEX HOSPITAL • 250K catchment area • Highly disadvantaged population ( 40K refugees and > 50% population English not first language) • 80K A and E attendances / year • 10K emergency admissions / year • Bedbase 250 approx

  8. CMH- BECAD(Brent Emergency Care and Diagnostic Centre) • DOH model of the “small district general hospital- (www.dh.gov.uk/policyand guidance/organisationpolicy/configuringhospitals) • Innovations over staffing/hospital at night • Filmless environment

  9. THE VIRTUAL NIGHT HOSPITAL? THE SOLUTION • Several hospitals link their PACS systems to a central reporting site • Portable video conferencing to referring hospitals (discussions with radiographers/ referring clinicians/ even patients?) • Consultant opinions at central reporting site - Radiology, A and E , ? Cardiology? others

  10. Virtual Night HospitalWork-Flow

  11. Hospital A n Image Repository & PACS Gateway Hospital B

  12. Hospital A Examinations for Reporting are sent to the VNH Image Repository & PACS Gateway (DICOM “processed” to support multiple PACS Vendors) Hospital B

  13. Hospital A Examinations reported directly into the On-Call Worksation and sent back to the Repository On-Call Workstation Hospital B

  14. Hospital A Teleconference Facilities make it possible to communicate between sites in real-time. This may also include streaming images such as Ultrasound. Hospital B

  15. Hospital A Examinations reported directly into the On-Call Worksation and sent back to the Repository On-Call Workstation Hospital B

  16. Hospital A Images and Report made immediately available via Web Based Viewer to referring site. Report may also be exported into RIS system. On-Call Workstation Hospital B

  17. Hospital A Fully Reciprocal Arrangement Hospital B

  18. Hospital C Highly Scalable Hospital E Hospital A Image Repository & PACS Gateway Hospital B Hospital F Hospital D

  19. THE VIRTUAL NIGHT HOSPITAL RADIOLOGY • ALL OUT OF HOURS PLAIN FILM AND CT REPORTING PERFORMED AT THE TIME • VIDEO CONFERENCING ALLOW CLINICAL DISCUSSIONS/ PROTOCOL MANAGEMENT FOR CT

  20. THE VIRTUAL NIGHT HOSPITAL RADIOLOGY PROBLEMS • INTERVENTIONAL ?- will require separate interventional rotas. If organised regionally, interventionalists could cover several hospitals (already beginning with vascular networks • ULTRASOUND?- X training nurse practioners (gynae), A and E – FAST. Videostreaming and remote robotic ultrasound possible

  21. THE VIRTUAL NIGHT HOSPITAL RADIOLOGY INDIRECT ADVANTAGES • Radiologist- Much reduced on-call commitment. Busy when on call but following day off • A and E films reported on time- less returns/ misses • Good acute training opportunities • Patients- 24 hour access to consultant opinion

  22. THE VIRTUAL NIGHT HOSPITALWHEN? Need working model by early 2006- commissioning of BECaD

  23. THE VIRTUAL NIGHT HOSPITALWHERE ARE WE NOW? • Gaining political support • Identifying funding • Investigating technology • Looking for partners

  24. THE VIRTUAL NIGHT HOSPITALWHERE ARE WE NOW? Technology PACS-Workstation which can receive different PACS company data/ PACS to PACS translation (Insignia) WEBbased return of reports Portable video conferencing- on 3G networks or via broadband- liaising with Kingston University Robotic Ultrasound - assessment

  25. THE VIRTUAL NIGHT HOSPITALWAY FORWARD IF ANY HOSPITALS WITH PACS ARE INTERESTED IN CONTRIBUTING TO A PILOT STUDY OF THIS CONCEPT- PLEASE CONTACT MYSELF OR DAVID POWELL (PROJECT LEADER FOR THE BECaD) philip.shorvon@nwlh.nhs.uk david.powell@nwlh.nhs.uk Or Mary McKenna on 02084532270

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