Reducing patient travel by providing “same day” ultrasound and nuclear medicine appointments

Reducing patient travel by providing “same day” ultrasound and nuclear medicine appointments. This project was part of the 2025 Green Team Competition at Norfolk and Norwich University Hospital (NNUH), implemented by the radiology department.

Setting/patient group:  Radiology services.

Issue

Children at NNUH often require both ultrasound (US) and nuclear medicine (NM) scans to assess the anatomical detail and function of the kidneys.  These scans are managed by two different booking teams and are historically booked for separate days.  This can be financially costly in terms of fuel, parking or public transport costs, environmentally costly in terms of carbon emissions associated with travel and a social burden of requiring time out of education for children and out of work for parents.

Aim

• To provide same day ultrasound and nuclear medicine appointments for children if:

• Both tests are needed in the same time frame.

• Both tests are requested at the same time.

Intervention 

Referrers were engaged with to ensure both studies were requested at the same time.  Vetting radiologists were requested to add a note identifying patients that were appropriate for “same day” appointments.  

A “same day” booking template was designed and US slots were reserved.

Outcomes

Outcomes were measured to identify the sustainable value using the triple bottom line approach.  23 patients could have been eligible for “same day” scans, 10 patients were enrolled in the study and 8 of those patients had their scans completed as plans.

Clinical outcomes:

• No adverse clinical effects. 

• Potential risk of reduced DNA. 

Environmental outcomes

• 8 out of 10 patients avoided one return episode of travel to the hospital, saving 232 miles and a conservative emissions saving of 88.18 kgCO2e.

• Estimated annual saving for the 23 eligible patients was 2,013.82 miles avoided and 594.60 kgCO2e, equivalent to 2,013.82.

• Staff were spurred on to identify other carbon saving projects.

Financial outcomes:

• Cost neutral.

• Possible financial saving through reduced DNA rates and increased booking team efficiency (not quantified).

Social outcomes:

• Parents valued only having to attend once, especially those outside the local Norwich area,

• Predicted 88 days of lost school or work avoided.

• Parents wanted same day appointments.

• Being at the hospital for a longer period was acceptable.

• Staff were excited to hear about the environmental impact they were having. 

Key learning points:

• It was possible to manually identify patients eligible for “same day” imaging, but this was labour intensive.  An individual needs identifying to have oversight of these patients.

• If both studies are not requested at the same time, it is very difficult to book the appointments at the same time.  Therefore, referrers need to anticipate if both scans are required.

• A compulsory yes/no box for “same day” appointments could be implemented on the referral form and populated onto a spreadsheet via Power BI.

• Differences between when US and NM release their appointments caused booking problems.  Reserving US slots via a booking template reduced this issue. 

• A “same day” US and NM appointment letter needs devising, to avoid patient confusion and minimise DNA risk.