From: Rob Hart <[EMAIL PROTECTED]>

The following is a small extract from a larger discussion on the ACEM list
in relation to nurse-initiated XR (NIXR). Interesting reading! My posting is
at the bottom, with the ED director of a large Eastern States hospital's
reply above.


>Brilliant
>
>In fact I did suggest at St Matyrs  when  NIXR came in & there were
>problems with a colleague encouraging them to ask for multiple  areas in
>case they missed the wrong one   & a lot  of problems with suboptimal
>imaging (half of a Jones # on ankle xray,   injured wrist right on the
>edge of a 30cm long film of forarm etc)    that  the nurses should stop
>at recognising probable need for xr and ask the radiographer to
>determine which xrays to take.
>
>It was the radiographers who refused. 
>
>Similarly,   when I managed (took a year!)  to introduce   provisional
>xray reports by the clinician so the  radiologist would know when we'd
>screwed up & notify us early,   I  tried to persuade the radiographers
>into the "redspot" system.  They were a really nice bunch of people, but
>chickened out - head radiographer says that's giving them clinical
>responsibility & they don't want it.  We had at that stage a lot of
>shifts covered only by juniors; I think the system is useful there.
>
> 
>
>>At 04:36 PM 12/11/2002 +0800, Rob Hart wrote:
>>Dear All
>> 
>>Perhaps I can put in a spoke here for the radiology depts. I am hopeful
>>that all, with or without NIXR, rely on the professional opinion of
>>their medical imaging staff (radiographers as were) in determining the
>>relevant imaging to be performed. I know when I was at Royal Perth ED
>>for 5 years as a diagnostic radiographer, we considered ourselves part
>>of the decision-making process even though we are not entitled to
>>"order" (we prefer "request", but let's not get pedantic!) imaging exams
>>ourselves.  In many cases we have seen many more of a particular #,
>>strain, sprain or other musculoskeketal injury than the refering intern
>>or RN/CN. This applies both to initial presentation, and to follow-up
>>zapping based on the results of the first series performed. Or is this
>>as polarised an issue (Dr initiated/NIXR) as it appears from the
>>outside?
>> 
>>Regards to all
>> 
>>Rob Hart


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