DXA Facilities Audit

Steven made this Freedom of Information request to University Hospitals Coventry and Warwickshire NHS Trust as part of a batch sent to 138 authorities Automatic anti-spam measures are in place for this older request. Please let us know if a further response is expected or if you are having trouble responding.

The request was successful.

Dear University Hospitals Coventry and Warwickshire NHS Trust,

The Royal Osteoporosis Society, in it’s capacity as secretariat for the All Party Parliamentary Group (APPG) on Osteoporosis and Bone Health, is making a Freedom of Information Act (FOI) request of all Trusts, Health Boards and Health and Social Care Trusts to assess DXA service provision and facilities.

The All Party Parliamentary Group will hold a hearing later this year on DXA service workforce, infrastructure and quality in the UK. To support the work of the group, Parliamentarians have asked for a Freedom of Information (FOI) request to be circulated to assess the level and quality of provision across the country. This is a positive, solution-focused assessment of how we can improve services for the 3.5m people living with osteoporosis in the UK.

Data will be used to assess how we can target future resources to ensure that all patients receive the highest level of care and that there is consistency of quality across services.

We appreciate your help with this information gathering exercise, especially as we understand the pressures that healthcare services continue to experience.

Please pass the questions below on to your DXA Service delivery lead, manager or clinical lead. If this is not possible, we would appreciate your help to provide as much information as you can.

Yours faithfully,
Craig Jones, CEO, The Royal Osteoporosis Society

Questions:

Infrastructure:

1) Do you outsource your DXA scans? If Yes- please state the organisation providing this service and forward this FOI to your provider for completion (please continue to complete for any of the elements of the DXA pathway that are provided by your Trust/board)

2) In January 2023 how many DXA scanning machines did you have at your trust/board for clinical use?
a. n. Operational
b. n. not in use
c. n. accessible outside of Trust

3) What is the average weekly capacity for clinical scans? (N. of scans per week)

4) What was your average DNA rate over the last 3 months? (n. DNA/total n. scans booked)

5) What age range do you include in your clinical scans? Please tick all that apply
a. <20 years
b. 20-40 years
c. 40-60 years
d. 60-75 years
e. 75-80 years
f. >80 years

6) What is the duration of your routine DXA appointment:
a. 15 minutes or less
b. 16-25 minutes
c. 26-30 minutes
d. >30 minutes

7) What was the average wait for clinical patients from referral to scan in January 2023?
a. <2 weeks (move to Q9)
b. 2-6 weeks (move to Q9)
c. 6-13 weeks
d. >13 weeks

8) What are your perceived barriers to delivering DXA scans within 6 weeks from referral? Please tick all that apply
a. Scanner capacity (DXA equipment)
b. Clinical capacity (operator)
c. Other- please state

9) What was the average time from the scan to the report being available to the referrer in January 2023?
a. <3 weeks (move to Q11)
b. 4-6 week
c. 6-13 weeks
d. >13 weeks

10) What are your perceived barriers to referrers receiving DXA scan reports within 3 weeks from scan? Please tick all that apply
a. Clerical- internal
b. Clinical- internal
c. Factors external to this service (please state)
d. Other (please state)

11) What hospital department is responsible for delivery of DXA scans:
a. Radiology
b. Medical physics
c. Nuclear medicine
d. Rheumatology
e. Other- please state

12) Which DXA examinations are included in routine protocols for the clinical service? Please tick all that apply
a. Lumbar spine
b. Proximal femur
c. Long femur (AFF assessment)
d. Total body
e. Vertebral fracture assessment (VFA)
f. Peripheral/forearm

13) What access facilities do you have available? Please tick all that apply
a. Overhead hoist
b. Portable hoist
c. Wheelchair transfers
d. Bed/trolly transfers
e. Changing room
f. assistance for transfers
g. Other- please state

Workforce:

1)
i) What professional groups perform DXA scan measurements at your center? (DXA operators)
a. Radiographer
b. DXA technician
c. Assistant practitioner
d. Clinical scientist
e. Nurse
f. Medical Dr- please state specialism
g. Other- please state
h. Unknown]

ii) Please indicate WTE for each group selected

2) What DXA-specific training (outside of professional training) have the DXA operators performing scans had?
a. In house
b. Manufacturers applications training
c. Recognized/accredited national training programme (please state the name of the training programme/provider)
d. Other- please state
e. unknown

3) What professional groups report your DXA scans at your center? ()
a. Radiographer - internal
b. Radiographer - external
c. DXA technician – internal
d. DXA technician - external
e. Assistant practitioner – internal
f. Assistant practitioner - external
g. Clinical scientist – internal
h. Clinical scientist - external
i. Nurse -internal
j. Nurse - external
k. Medical Dr – internal - please state specialism(s)
l. Medical Dr – external - please state specialism(s)
m. Other- please state
n. Reporting is outsourced
o. unknown

4) What training (outside of professional training) have those reporting DXA scans had- specifically in DXA reporting?
a. In house
b. Manufacturers applications training
c. Recognized/accredited national training programme (please state the name of the training programme/provider)
d. Other- please state
e. unknown

5) What professional group provides clinical leadership for your service?
a. Radiographer
b. DXA technician
c. Assistant practitioner
d. Clinical scientist
e. Nurse
f. Medical Dr- please state specialism(s)
g. Other- please state
h. unknown

6) Please indicate how many (WTE) clinical vacancies in your DXA service do you have in January 2023? (Free text)

Quality:

1) Is your service accredited as part of a national programme?
a. ISAS
b. IOS
c. Other- please state
d. None
e. Unknown

2) What clinical audits do you routinely undertake? Please tick all that apply
a. DXA scan technique
b. Reporting (double reporting)
c. Reporting (clinical review)
d. Scanner QA review
e. Other- please state
f. unknown

3) What IR(ME)R audits do you routinely undertake? Please tick all that apply
a. Patient pregnancy
b. DXA dose audit
c. Referrer entitlement
d. Scan justification
e. Other- please state
f. unknown

4) What clinical protocols do you have in place? Please tick all that apply
a. Scan site
b. Scan mode
c. Reference data selection
d. Patient positioning
e. Scan analysis
f. Interpretation- T&Z-scores
g. Reporting
h. Other- please state
i. Unknown

5) Which of the following are routinely included in the DXA report issued to the PRIMARY CARE referrer? Please tick all that apply
a. Admin. details
i. Date of assessment
ii. Patient ID and demographics
iii. Reason for referral
iv. Reporter’s ID
b. BMD results for each measurement site
i. T score (after peak bone mass)
ii. Z score
iii. Rate of change for serial measurements
c. Comment on reliability of measurements
i. BMD results
ii. Documentation of excluded measurements eg vertebrae
iii. Statistical significance of rate of change
iv. Clinical significance of rate of change
d. WHO diagnostic category (for adults after peak bone mass)
e. Results of additional investigations performed at DXA appointment
i. VFA
ii. X-ray or other imaging
iii. Laboratory tests
f. Summary of clinical risk factors for fracture
g. Summary of fracture history
h. Clinical interpretation to quantify absolute fracture risk
i. FRAX+BMD
ii. FRAX + TBS
iii. FRAX+BMD plus comment on additional adjustment
iv. Statement on level of risk based on clinical judgement (eg low/moderate/high)
i. Management advice
i. Reference to national guideline (NICE/NOGG/ROS)
ii. Reference to local management guideline
iii. Individualised advice
j. Recommendations on:
i. Need for onward referral eg falls assessment or additional investigation
ii. Timing of future scan

6) Which of the following are routinely included in the DXA report issued to the SECONDARY CARE referrer? Please tick all that apply
a. Admin. details
i. Date of assessment
ii. Patient ID and demographics
iii. Reason for referral
iv. Reporter’s ID
b. BMD results for each measurement site
i. T score (after peak bone mass)
ii. Z score
iii. Rate of change for serial measurements
c. Comment on reliability of measurements
i. BMD results
ii. Documentation of excluded measurements eg vertebrae
iii. Statistical significance of rate of change
iv. Clinical significance of rate of change
d. WHO diagnostic category (for adults after peak bone mass)
e. Results of additional investigations performed at DXA appointment
i. VFA
ii. X-ray or other imaging
iii. Laboratory tests
f. Summary of clinical risk factors for fracture
g. Summary of fracture history
h. Clinical interpretation to quantify absolute fracture risk
i. FRAX+BMD
ii. FRAX + TBS
iii. FRAX+BMD plus comment on additional adjustment
iv. Statement on level of risk based on clinical judgement (eg low/moderate/high)
i. Management advice
i. Reference to national guideline
ii. Reference to local management guideline
iii. Individualised advice
j. Recommendations on:
i. Need for onward referral eg falls assessment or additional investigation
ii. Timing of future scan
k. The secondary care report is the same as the primary care report

uhcw@infreemation.co.uk, University Hospitals Coventry and Warwickshire NHS Trust

 
University Hospital
Clifford Bridge Road
Walsgrave
Coventry
CV2 2DX

Direct Line: 024 76968771
www.uhcw.nhs.uk

 

Dear Requester

We acknowledge receipt of your email to UHCW:

Freedom of Information Request Form

If you have submitted a request under the Freedom of Information Act
(FOIA) your request will be considered and you will receive our response
within the statutory timescale of 20 working days.

The reference number for your email is FOI/2439.

Should you have any further inquiries concerning this matter, please reply
to this email leaving the subject line unchanged.

Yours sincerely,
UHCW

uhcw@infreemation.co.uk, University Hospitals Coventry and Warwickshire NHS Trust

 
University Hospital
Clifford Bridge Road
Walsgrave
Coventry
CV2 2DX

Direct Line: 024 76968771
www.uhcw.nhs.uk

 

Our Ref: FOI/2439
Date: 1 March 2023

By email only

 

Dear Requester

We write further to your request for information under the Freedom of
Information Act received 1 February 2023.  We have set out your request,
together with our response below. 

1) Do you outsource your DXA scans? If Yes- please state the organisation
providing this service and forward this FOI to your provider for
completion (please continue to complete for any of the elements of the DXA
pathway that are provided by your Trust/board) No

2) In January 2023 how many DXA scanning machines did you have at your
trust/board for clinical use?
a. n. Operational - 1
b. n. not in use - 0
c. n. accessible outside of Trust - 0

3) What is the average weekly capacity for clinical scans? (N. of scans
per week) 80

4) What was your average DNA rate over the last 3 months? (n. DNA/total
n.. scans booked) 6%

5) What age range do you include in your clinical scans? Please tick all
that apply
a. <20 years X
b. 20-40 years
c. 40-60 years
d. 60-75 years
e. 75-80 years
f. >80 years

6) What is the duration of your routine DXA appointment:
a. 15 minutes or less X
b. 16-25 minutes
c. 26-30 minutes
d. >30 minutes

7) What was the average wait for clinical patients from referral to scan
in January 2023?
a. <2 weeks (move to Q9)
b. 2-6 weeks (move to Q9) X
c. 6-13 weeks
d. >13 weeks

8) What are your perceived barriers to delivering DXA scans within 6 weeks
from referral? Please tick all that apply
a. Scanner capacity (DXA equipment)
b. Clinical capacity (operator)
c. Other- please state

9) What was the average time from the scan to the report being available
to the referrer in January 2023?
a. <3 weeks (move to Q11) X
b. 4-6 week
c. 6-13 weeks
d. >13 weeks

10) What are your perceived barriers to referrers receiving DXA scan
reports within 3 weeks from scan? Please tick all that apply
a. Clerical- internal
b. Clinical- internal
c. Factors external to this service (please state)
d. Other (please state)

11) What hospital department is responsible for delivery of DXA scans:
a. Radiology X
b. Medical physics
c. Nuclear medicine
d. Rheumatology
e. Other- please state

12) Which DXA examinations are included in routine protocols for the
clinical service? Please tick all that apply
a. Lumbar spine X
b. Proximal femur X
c. Long femur (AFF assessment)
d. Total body
e. Vertebral fracture assessment (VFA)
f. Peripheral/forearm X

13) What access facilities do you have available? Please tick all that
apply
a. Overhead hoist
b. Portable hoist X
c. Wheelchair transfers X
d. Bed/trolly transfers X 
e. Changing room X
f. assistance for transfers X
g. Other- please state

Workforce:

1)
i) What professional groups perform DXA scan measurements at your center?
(DXA operators)
a. Radiographer X
b. DXA technician
c. Assistant practitioner
d. Clinical scientist
e. Nurse
f. Medical Dr- please state specialism
g. Other- please state
h. Unknown]

ii) Please indicate WTE for each group selected

2) What DXA-specific training (outside of professional training) have the
DXA operators performing scans had?
a. In house X
b. Manufacturers applications training X
c. Recognized/accredited national training programme (please state the
name of the training programme/provider) X
d. Other- please state
e. unknown

3) What professional groups report your DXA scans at your center? ()
a. Radiographer - internal X
b. Radiographer - external
c. DXA technician – internal
d. DXA technician - external
e. Assistant practitioner – internal
f. Assistant practitioner - external
g. Clinical scientist – internal
h. Clinical scientist - external
i. Nurse -internal
j. Nurse - external
k. Medical Dr – internal - please state specialism(s)
l. Medical Dr – external - please state specialism(s)
m. Other- please state
n. Reporting is outsourced
o. unknown

4) What training (outside of professional training) have those reporting
DXA scans had- specifically in DXA reporting?
a. In house X
b. Manufacturers applications training
c. Recognized/accredited national training programme (please state the
name of the training programme/provider)
d. Other- please state
e. unknown

5) What professional group provides clinical leadership for your service?
a. Radiographer X
b. DXA technician
c. Assistant practitioner
d. Clinical scientist
e. Nurse
f. Medical Dr- please state specialism(s)
g. Other- please state
h. unknown

6) Please indicate how many (WTE) clinical vacancies in your DXA service
do you have in January 2023? (Free text)

Quality:

1) Is your service accredited as part of a national programme?
a. ISAS
b. IOS
c. Other- please state
d. None X
e. Unknown

2) What clinical audits do you routinely undertake? Please tick all that
apply
a. DXA scan technique
b. Reporting (double reporting)
c. Reporting (clinical review)
d. Scanner QA review
e. Other- please state
f. unknown

3) What IR(ME)R audits do you routinely undertake? Please tick all that
apply
a. Patient pregnancy
b. DXA dose audit
c. Referrer entitlement
d. Scan justification
e. Other- please state
f. unknown

4) What clinical protocols do you have in place? Please tick all that
apply
a. Scan site X
b. Scan mode X
c. Reference data selection X
d. Patient positioning X
e. Scan analysis X
f. Interpretation- T&Z-scores X
g. Reporting X
h. Other- please state
i. Unknown

5) Which of the following are routinely included in the DXA report issued
to the PRIMARY CARE referrer? Please tick all that apply
a. Admin. details
i. Date of assessment X
ii. Patient ID and demographics X
iii. Reason for referral
iv. Reporter’s ID X
b. BMD results for each measurement site
i. T score (after peak bone mass) X
ii. Z score X
iii. Rate of change for serial measurements X
c. Comment on reliability of measurements 
i. BMD results X
ii. Documentation of excluded measurements eg vertebrae X
iii. Statistical significance of rate of change X
iv. Clinical significance of rate of change X
d. WHO diagnostic category (for adults after peak bone mass)
e. Results of additional investigations performed at DXA appointment
i. VFA
ii. X-ray or other imaging
iii. Laboratory tests
f. Summary of clinical risk factors for fracture
g. Summary of fracture history
h. Clinical interpretation to quantify absolute fracture risk
i. FRAX+BMD
ii. FRAX + TBS
iii. FRAX+BMD plus comment on additional adjustment
iv. Statement on level of risk based on clinical judgement (eg
low/moderate/high)
i. Management advice
i. Reference to national guideline (NICE/NOGG/ROS)
ii. Reference to local management guideline
iii. Individualised advice
j. Recommendations on:
i. Need for onward referral eg falls assessment or additional
investigation
ii. Timing of future scan

6) Which of the following are routinely included in the DXA report issued
to the SECONDARY CARE referrer? Please tick all that apply
a. Admin. details
i. Date of assessment X
ii. Patient ID and demographics X
iii. Reason for referralX
iv. Reporter’s ID X
b. BMD results for each measurement site
i. T score (after peak bone mass) X
ii. Z score X
iii. Rate of change for serial measurements
c. Comment on reliability of measurements X
i. BMD results X
ii. Documentation of excluded measurements eg vertebrae X
iii. Statistical significance of rate of change X
iv. Clinical significance of rate of change X
d. WHO diagnostic category (for adults after peak bone mass)
e. Results of additional investigations performed at DXA appointment
i. VFA
ii. X-ray or other imaging
iii. Laboratory tests
f. Summary of clinical risk factors for fracture
g. Summary of fracture history
h. Clinical interpretation to quantify absolute fracture risk
i. FRAX+BMD
ii. FRAX + TBS
iii. FRAX+BMD plus comment on additional adjustment
iv. Statement on level of risk based on clinical judgement (eg
low/moderate/high)
i. Management advice
i. Reference to national guideline
ii. Reference to local management guideline
iii. Individualised advice
j. Recommendations on:
i. Need for onward referral eg falls assessment or additional
investigation
ii. Timing of future scan
k. The secondary care report is the same as the primary care report

As we have provided the information that we do hold your request is now
closed.  We trust that this is satisfactory but if you are dissatisfied
with the way that it has been handled you have the right to ask for an
internal review.  Internal review requests should be submitted within two
months of the date of receipt of the response to your original letter and
should be addressed to: David Walsh, Director of Corporate Affairs,
University Hospitals Coventry & Warwickshire NHS Trust, Clifford Bridge
Road, Coventry CV2 2DX.

If you are not content with the outcome of the internal review, you have
the right to apply directly to the Information Commissioner for a
decision.  The Information Commissioner can be contacted at: Information
Commissioner’s Office, Wycliffe House, Water Lane, Wilmslow, Cheshire, SK9
5AF.

Yours sincerely

 

 

 

Andrea Phillips
FOI & Access to Health Records Manager