When Imperial College Hospital radiology trainees logged on for their night shifts in Summer 2019, they had a welcome surprise – a message from consultant Dr. Elizabeth Dick telling them that she would be reporting with them throughout the night, in addition to the usual on-call consultant. However, she wasn’t reporting from the hospital, or even from home; in fact, she was logged on 18,000km away in Sydney, Australia.

Dr. Elizabeth Dick, a Consultant Radiologist at Imperial College NHS Trust, London, delivered a remote radiology service from Sydney, Australia, in the summer of 2019.

A new pilot reporting scheme, using novel application of virtualisation technology provided by VMware, allowed secure access to the trust’s radiology reporting platform and electronic patient record. The nine-hour time difference between London and Sydney meant that Elizabeth was alert and working daytime hours during the UK night, so emergency patients could have their imaging routinely reviewed by a consultant during the night, rather than waiting until the following morning.

Radiology trainees and emergency teams were able to communicate via telephone and the existing messaging service to talk to Elizabeth about critical imaging findings, making essential changes to the patient’s management. The statistics were impressive too: the time taken for consultant authorisation of final emergency reports decreased by 40% during the pilot study and reporting output overall (numbers of scans reported) increased by 147%.

The pilot was made possible by great teamwork from the Imperial College Healthcare Trust ICT and Imaging ICT department who set up the virtual desktop environment. The physics department set up a quality assurance programme to ensure video display standards were maintained from all reporting sites. The remote reporting pilot aligned with the hospital’s human resources vision by enabling workforce agility and flexibility for all involved. Outside of the hospital, external agencies including Creative ITC provided technical support 24/7 and Everlight Radiology hosted Dr. Dick in Sydney. From the point of view of indemnity, this was continued as normal, as the patients were scanned and reported in the UK.

For registrars and Dr. Dick, what was it like being so far from each other?

Dr. Miriam Salib, radiology registrar: I really appreciated that she messaged us to let us know that she was free for checking and advice and it was just really nice to know that there was someone to ask if there were any problems.

Dr. Elizabeth Dick: Initially it was a little overwhelming to be so remote. However, I soon realised that with good communication, I was actually just as connected as if I was in the building – I could phone everyone and talk to them, send messages via email or the internal messaging system and review all images as quickly as if I was in the UK. Additionally, my clinical colleagues were so pleased to be able to discuss cases with me throughout the night – this was a real bonus and made a difference in several patients. I also noticed that the radiology registrars felt more confident asking me about ‘small’ things, since they knew I was awake anyway. These were questions they would not necessarily have wanted to wake me up for.

Were there any glitches?

Dr. Elizabeth Dick: In the first week I had a few glitches when I had to call the backup IT team, Creative ITC, for help in re-starting my login. But they were always incredibly helpful and got me going very quickly. I soon realised that not only could I handle most of the glitches myself, but also that I would always have someone to rely on, whatever the time of day or night. Within two weeks almost all of the glitches were resolved.

Were there any unexpected benefits?

Dr. Elizabeth Dick: It was a real benefit for me to spend time in the Everlight Radiology office and learn more about how they work. Particularly, I was very impressed with how they run their learning and discrepancy programme. They routinely review 10% of reports and have a method of flagging up outstandingly good reports, which I think is so valuable for any radiologist. I would really like to imitate this practice!

Were there any particular educational opportunities?

Dr. Elizabeth Dick: I delivered two webinars for Everlight (in return for their hosting me) which were viewed by radiologists from more than 60 countries worldwide. We had a fantastic live discussion, with people from several continents around the world contributing; this was a great example of massive online open learning!

Would you recommend this to others?

Dr. Elizabeth Dick: 100%. It was really great to ‘walk in the shoes’ of the registrars, doing a night shift with them. I had the opportunity to learn from Australian doctors too, as Visiting Professor at the University of Sydney, lecturing at the Royal North Shore hospital. Apart from the work aspect, it was good to spend time with my family. I came back from the pilot feeling refreshed.

Dr. Elizabeth Dick is a Consultant Radiologist at Imperial College NHS Trust, London, UK, and President of the European Society of Emergency Radiology. Dr. Dimitri Amiras is a Consultant Radiologist and Imaging IT Lead at Imperial College NHS Trust. Laurence Musker is Director of IT at the Radiology Department, Imperial College NHS Trust. Dr. Amrish Mehta is a Consultant Radiologist and Chief of Service at the Radiology Department, Imperial College NHS Trust, London. UK.

Acknowledgements: we wish to thank those who helped to set up and assess the pilot: Poopak Sadeghi, Rex Rexhmati, Pushpak Nayak, Nelofur Hayat, Dr. Anish Raithatha, Everlight Radiology Team and the Creative ITC team.

Disclosures:

Dr. Dick was hosted for free by Everlight Radiology while in Sydney in return for delivering two webinars.