HNY Policy and Pathway Repository - Humber

An X-ray is a fast, painless medical imaging procedure that uses a small dose of electromagnetic radiation to create pictures of the inside of your body. It is most commonly used to diagnose broken bones, joint problems, dental issues, and lung conditions like pneumonia

This pathway is provided by Hull University Teaching Hospitals NHS Trust’s Radiology Service and exists for GPs (Medical Practitioners) in Hull and East Yorkshire to refer patients who require diagnostic Xray imaging provided minimum referral criteria is met.  All diagnostic tests will be undertaken within 6 weeks of the request being received in the department   Planned follow up referrals will be appointed within the required timeframe indicated.

Various x-ray techniques can be offered and are detailed with the Guidance below.

Urgent referrals must be sent via ERS and marked accordingly with explanation as to why an urgent appointment is required. Any recent trauma must be directed to Urgent Treatment Centre or Emergency Department.

Clinical judgement is required on the test, but also that other diagnostics may be more appropriate. This can be reviewed with Radiology through Advice and Guidance.  If an x-ray is beneficial as the diagnostic, then the referral can be made.  

Guidance on using the advice and guidance element of ERS is available below

• Enhanced advice and guidance overview
• Managing advice and guidance requests

Radiology Process

For queries use our Advice and Guidance on ERS. If you are a clinician without access to ERS please email hyp-tr.HEYRadiologyEnquiries@nhs.net.

GP Advice and Guidance process with HUTH Radiology Department:

• GP sends Advice and Guidance query via NHS ERS before referral to ensure it is appropriate and the correct modality
• Radiology HUTH regularly check the Advice and Guidance to ensure a response within 48 working hours.
• Queries will be filtered to gain a response from either the On-call Radiologist, the Acute Cover Neuroradiologist or an Acute Cover MSK Radiologist
• Radiologist will reply to the Advice and Guidance via ERS (this will be visible in the practice ERS work list)

Radiology Process

For queries use our Advice and Guidance on ERS. If you are a clinician without access to ERS please email hyp-tr.HEYRadiologyEnquiries@nhs.net.

GP Advice and Guidance process with HUTH Radiology Department:

• GP sends Advice and Guidance query via NHS ERS before referral to ensure it is appropriate and the correct modality
• Radiology HUTH regularly check the Advice and Guidance to ensure a response within 48 working hours.
• Queries will be filtered to gain a response from either the On-call Radiologist, the Acute Cover Neuroradiologist or an Acute Cover MSK Radiologist
• Radiologist will reply to the Advice and Guidance via ERS (this will be visible in the practice ERS work list)

PLEASE NOTE: Once a response has been received and no further action is required, please ensure you click the “end conversation” button within the worklist screen. If the conversation is not ended it will remain on the provider’s worklist.

Radiology can use x-ray for various diagnostics, therefore there are some differences in provision.  The Radiologists will review referrals and ensure they are appropriately appointed.  It is beneficial to use the following guidance: -

• www.irefer.org.uk  (If accessible)
• HUTH - Guidance to Primary Care on X-Ray referrals

 Plain Film X-Ray Appointments (non-urgent/within in 6 weeks)

These are provided at the following locations

• Hull Royal Infirmary
• Castle Hill Hospital
• East Riding Community Hospital (Beverley)
• Hull and ER. Community Diagnostic Centre
• Bransholme Healthcare Centre
• Jean Bishop Integrated Care Centre
• Withernsea Community Hospital
• Hornsea Cottage Hospital

For referrals to Hornsea please contact their booking team on 01964 533146 (Monday to Friday 9am to 4pm)

Please check with the patient that they wish to receive this diagnostic, can be available at a local site and that they are able to stay still during the X-ray and/or hold their breath when/as asked to ensure the images are not blurred and are suitable for diagnosis purposes.

For Plain x-Ray with Fluoroscopy (I.e. Barium Meal please use the Plain Film referral form, adding the request as part of the referral information.  Provision of fluoroscopy is only at HRI and CHH.

Chest X Ray - a walk in service with no appointment required is available at Castle Hill Hospital only (Monday to Friday 9am to 4pm).  An ERS referral must have been submitted. (dedicated form)

URGENT REQUESTS

If patients do not meet the ‘walk in referral’ criteria, we will always try and appoint within 2 days.  Please indicate the urgency of the referral on the Plain Xray Form as well as contacting Radiology.  The patient will be contacted by phone to confirm the appointment.

DO NOT REFER

• Patient is too unwell or unable to attend as an outpatient or needs acute admission
• Limited clinical history and / or an unclear clinical question 

REFERRALS

The service can be accessed via the Electronic Referral Service (ERS) under RWA for HUTH services. The full Directory of Services (DoS) and the correct referral form is all available in the DoS and for GPs through ARDENS. A fully completed plain film imaging ERS request form is required for every examination undertaken.

A medically qualified person or a suitably qualified, registered non-medical practitioner must complete the ERS referral. This a legal requirement as per the Ionising Radiation (Medical Exposure) Regulations 2017 - Regulation 10, section 5.

INFORMATION TO INCLUDE ON THE REFERRAL

• Name, Designation and GMC / NMC or HCPC Reg No. of referrer.  
• Please include your Practice code and the patient NHS number on the request form, this information enables us to process the referrals more efficiently and ensures the timely receipt of reports being sent to the correct GP practice email address.
• Please include mobile telephone number of the patient to ensure the patient receives a text reminder of their appointment date, time and location.
• Hornsea requests please contact the booking team for these appointments - 01964 533146 – Clinicians only

Referral forms are available to GP’s in Ardens for Plain Film X-Ray and Walk in Chest Xray (CHH only)

REFERRAL CRITERIA

Please refer to the links below for referral criteria. These will enable referrers to ensure that the appropriate imaging test is conducted at the right time.

• www.irefer.org.uk  (If accessible)
• HUTH - Guidance to Primary Care on X-Ray referrals

Limited clinical history and / or an unclear clinical question – ambiguous or limited information may result in the incorrect clinical question being interpreted by the radiographer undertaking the examination. A clear clinical question which can be answered by imaging will optimise the usefulness of the test.

APPOINTMENTS

Non-Urgent Appointments

An appointment is sent to the patient once the completed ERS referral form has been received. A text message is sent to the patient at 7 days and 2 days before the appointment.  Patient leaflets and information will be shared with the appointment letter.

ALL X-rays will be reviewed by a dedicated reporting team who will report on the image.  The report will be shared with the patients GP practice within 28 days after imaging the response will be shared electronically.  

• Hull University Teaching Hospitals