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This business case focuses on computed tomography on a hospital in the Kingdom of Saudi Arabia. Computed tomography or CT scanning is an X-ray system with the help of detailed cross sectional images of various areas of the body can be obtained. Before the test is conducted, the patients need to be made aware of correct preparation and what they are expected to do so that the test proceeds in a successful manner (Keyak and Falkinstein, 2003). It is proposed that a patient must be first referred to a pre CT scan preparation clinic by the physician when decision to write CT scan request has been made. The aim of the current project is to introduce a pre CT scan service/clinic for patients undergoing a CT scan. According to NHS, a total number of 4.7 million computed imaging tests were performed in the UK from April 1 to 2012 to March 31 2013. Over the past year, there has been 7.9 per cent of growth in the CT scan tests (NHS Imaging and Radio diagnostic activity in England, 2013). In addition to their use in cancer, these have also been used for diagnosing medical conditions such as coronary artery disease, blood vessel aneurysms, blood clots, spinal conditions, kidney and bladder stones, inflammatory conditions such as sinusitis and ulcerative colitis etc. These are also used for diagnosing injuries to head, skeletal system and internal organs. Patients generally lack information about the radiation exposure during CT scan and the risks associated with it. This has significant impact on the health of the patients as radiation exposure has been known to cause cancer (Pearce, Salotti and González, 2012). The physicians are also risking the lives of the patients by not informing them about the adverse effects of exposure to the radiation.
The risk related to the CT scan is managed by the health care organizations with the help of various strategies. Effective radiation safety committee has been set up that has the input of a physicist. Guideline protocols are followed for patients who are more sensitive to the radiation such as younger patients. There is a need to improve a quality culture in the provision of CT scan test. This project aims to introduce a pre CT scan assessment clinic for the patients undergoing the scans. The project is conducted with the aims and objectives that have been designed using SMART criteria (Appendix1). These objectives help in providing justification for the need for such a project. The objectives of the proposed project are to:
Computed tomography is a diagnostic tool that is used by the doctors to see inside the body. The information provided by the CT scans is used by the physicians to rule out or confirm the presence of certain abnormalities. Although the CT examination is quick and clear yet there are several questions in the minds of the patients that need to be answered. Prior to the CT scan, various aspects need to be considered. It needs to be checked if the patient is allergic to the dye that is being used in the scan (Preparing for your PET/CT scan, 2014). Allergies of the patient to foods and other products also need to be reflected on. There are other ways in which the patient is to be prepared before the test is conducted. Also, preparation needs to be done on the part of the CT scan technicians and radiologists so that the test is conducted smoothly. There are certain medications that should not be taken before the test. Often, patients do not have much information regarding the procedure that is followed during a CT scan. They are generally not aware of the things they are expected to do before and during the test. This results in complications during the test for which both the patient as well as the technicians is responsible. Also, the patients want to know what is done in a CT scan (Partrick and et.al., 2003). In this context, pre preparation is essential for both patients as well as the health care professionals conducting the test. But, it is more important for the patient to know about the things that should and should not be done before and during the test. Pre preparation before the CT scan test will help in making the patient more comfortable with the test. For the test to be conducted in the best possible manner, it is important for the patient to trust the CT scan technologist.
CT scan is a non-invasive, painless medical procedure which usually takes 10 to 30 minutes to be performed. Although the scan does not hurt but patients often find it uncomfortable to lie within the scanner. As there is no opportunity for the patients to talk about the details and procedure of the test, they are not aware of the process and the devices that are used for conducting the test. As such, the patients often feel helpless and uneasy during the test. What will happen during the procedure was not explained to them (Nickoloff and Alderson, 2001). As such, due to lack of awareness of the patients about the CT scan, various issues arise which need to be addressed. Lack of awareness of the patients as to what they should do before the test and what does a CT scan expects them to do, make the patients unprepared for the test. As a result of this, elderly patients and the children who are to undergo a CT scan, are scared and feel nervous.
Lack of information provision about the risks of CT scans is a serious issue that surrounds the practice of diagnosing with the use of CT scans. Patients are not aware of the radiation exposure during the scan and its side effects. Another issue that arises regarding the CT scan is the characteristics of the individual body such as allergies etc. As a result of this, problems arise in case a patient is allergic to the intravenous contrast material that is required while conducting some scans (What are the risks of CT or CAT scans?, 2011). This often results in reactions such as itchiness. For this there is a need for platform at which the patients can have their queries answered which makes them feel comfortable with the test. One such proposal can be pre CT preparation clinic. The present project on the topic pre CT preparation clinic has been conducted with the view of making communication between the patients and the CT technician and between the patient and radiologist. Also, the technologists will be enabled to provide proper instructions to the patients that are to be followed by them before, during and after the test.
The drivers for the project can be categorized into three levels. These are at local level, national level and service intelligence. At the local level, the main drivers for the project were the complaints that were made by the people at the local level. People often report about the discomfort and nervousness that they experience while undergoing the test. Also, the doctors at the local level describe the complications that occur when the patient do not follow the instructions. They also report about the complications that occur as some people are allergic to various substances that are used in the test (Brix and et.al., 2005). At the national level, need was felt to improve the overall quality of the health care by analyzing the gaps that lead to the issues experienced by the patients during CT scan. For this, there was a need to identify the issues that are experienced by the patients and develop options that could help in building a platform for bringing the patient, radiologists, doctors and CT technicians at one level where they could communicate. Various loopholes were identified that necessitated to undertake the project. Hence, the project was conducted for developing quality frameworks to prepare the patients before the CT scan for positive patient outcomes.
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Risk analysis involves evaluation of the risks and their probability of occurring (REF). This involves techniques that are utilized for identifying and assessing factors that may alter the success of a particular project (Lee and et.al, 2004). Risk analysis helps in recognizing the barriers that may be faced while undertaking the project. Hence, the risks for undertaking the project can be identified with the help of risk analysis. Costs required for setting up a pre CT scan preparation clinic may be one of the risks that may be faced while conducting the project. If the costs for setting up pre CT scan assessment clinic are higher, the project may not get the required support. Non acceptance by the CT staff is another risk that may be faced by the project. This may serve as a hindrance in the successful running of the project. Resources are required for every project be it small or large (LoBiondo-Wood and Haber, 2006). Lack of availability of resources can be a risk for undertaking the project. The project is to be conducted with the purpose of providing the patients with an opportunity with the help of which they can get informed about CT scans and the risks associated with it. But, if no clear guidelines are available for providing information, the project cannot be undertaken in a successful manner. Hence absence of clear standards of information provision is a risk for undertaking this project (Goske and et.al., 2008).
Those individuals, internal or external to the organization, who have interest in the project or can influence the proposed project, are known as the stakeholders. Analysis of the stakeholders is significant as it will help in knowing the power that every stakeholder has and the impact they can have on the proposed project. By having knowledge about this, the project can be undertaken in an unobstructed manner thereby serving the interests of all the stakeholders.
The various stakeholders in the present case are:
Patients- The present project will benefit the patients in a number of ways. Patients who undergo CT scan are the focal point of the project. The project aims to provide satisfaction to the patients with the help of pre CT preparation clinic (Brooker and Waugh, 2013). This will facilitate communication between the patients and the technicians. As such, the patients will be able to clarify their doubts related to the procedure of CT scan. They will be medically and mentally prepared for the test.
Radiologist- The project will aid the radiologist to reduce the risks associated with the lack of patient awareness about the CT scan (Sapko, 2013). They will be provided guidance for dealing with the issues and problems that the patients suffer from during the computed tomography scan. In this way they will be able to consider the risks and benefits associated with preparing the patients about CT scan beforehand. Also to give a good diagnosis about the problem and suggestions treatment.
<p">CT technician- CT technician performs the work of following proper safety procedures for conducting the scan (Melnyk and Fineout-Overholt, 2005). The project will enable him to understand the importance of communicating with the patient before carrying out the CT examination. As such, he will be able to manage the equipment and patients, especially those who are disabled, in a better manner.
Director of radiology- The project analyses the issues faced by the patients that demand a pre CT preparation clinic (Brooker, Nicol and Alexander, 2011). With this, the director of radiology will be able to perform quality control procedures that could help in reducing the risks that are posed to the patients if they are not prepared for the test. He will facilitate effective communication between the patient and the CT technician and radiologist. For the patients who are unable to read, the director of radiology can make arrangements for such people where they could be explained about the procedure and the risks associated with it. Professional interpreters can be used for providing instructions to such patients. The option of providing verbal instructions to such patients can also be considered.
|Low impact/stake holding||High impact/stake holding|
|High Power||Director of radiology
|Ministry of health
Director of hospital
|Low Power||Ct technician
The service of per CT preparation clinic can be evaluated by collecting data from the stake holders. For this, various data collection methods can be used. This can be done by utilizing face-to-face interviews, telephone interviews and questionnaires. Telephonic interviews can be used for collecting data from the radiologists and CT technicians (Yousem, 2012). High quality data about the effectiveness of the pre CT preparation clinic can be obtained from the patients with the help of face-to-face interviews. This is because the subject matter is sensitive. This method is also preferable as the interview is likely to be lengthy. Evaluation strategy for the proposed project can be strengthened by considering measuring the reduced adverse events associated with the proposed project. This will help in ascertaining the current position of the project in terms of excellence. It can also be evaluated by measuring the patient satisfaction regarding the introduction of pre CT scan assessment clinic. The level of patient satisfaction will demonstrate the effectiveness of the proposed project and its level of efficiency.
From the project it can be concluded that after requesting the patient for a CT scan, the physician should first refer the patient to the pre CT scan preparation clinic so that he can obtain complete instructions regarding the situation he will face during the computed tomography procedure. This will help in the achievement of patient satisfaction by facilitating communication between the patient and the CT technician (Ellis and Hooper, 2009). Risk analysis and stakeholders are important aspects to be considered for bringing a change with the help of this service.
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