Cleveland Clinic London Hospital

On this page

• Overview
• Assessing needs
• Delivering evidence-based care and treatment
• How staff, teams and services work together
• Supporting people to live healthier lives
• Monitoring and improving outcomes
• Consent to care and treatment

Evidence-based practice was embedded in all aspects of the service and staff sought continuous improvement by adapting the most up to date national and international guidance to the needs of patients. The provider sought leading-edge standards in imaging equipment and research. Managers and subject matter experts supported the imaging team to ensure policies and standards of practice led to the best patient outcomes. Multidisciplinary practice was a fundamental aspect of the service and staff worked collaboratively with other specialists and support services to coordinate care. Staff were demonstrably focused on patient needs and worked with them to make long-term health improvements.

This service scored 79 (out of 100) for this area. Find out what we look at when we assess this area and How we calculate these scores.

Professionals with General Medical Council (GMC) or equivalent registration were permitted to refer patients to the service. Radiologists reviewed each referral and then protocoled the scan based on the patient’s needs, medical history, and presenting problems. The electronic records system enabled multidisciplinary staff to have a whole view of care and treatment, which supported informed decision-making. Staff used national and international assessment and management tools to measure levels of pain and used national guidance to support patients who found it difficult to express pain. Staff were skilled in assessing holistic needs and worked with patients to adapt the service. For example, they recognised the risk of claustrophobia in the MRI scanner and offered patients support to minimise discomfort. Staff provided ear plugs and headphones, but recognised these could worsen claustrophobia. They worked with each individual to make a balanced choice. Staff developed a standard operating procedure (SOP) to help support patients with a range of additional needs specific to the imaging environment. For example, they recognised those living with neurodiversity or a learning disability could be frightened, confused, or intimidated by the equipment. To improve comfort, staff reviewed national good practice guidance and incorporated this into local procedures. Referrers flagged such needs on the electronic health record and imaging staff contacted the patient in advance to discuss how they could best be accommodated. Staff worked to adapt the service by offering extended access times and giving patients a tour of the equipment before their scan day. Staff demonstrated attention to detail in their use of the SOP. For example, they recognised some lighting and temperature conditions could cause distress in patients living with some health conditions and worked with people in advance to adjust the environment whilst maintaining safety.

Policies, standard operating procedures (SOPs), and training were based on up-to-date guidance from professional bodies including the Royal College of Radiologists (RCR) and the College of Radiography. Staff used a quality assurance programme that assured evidence-based care.

Staff monitored standards of care through 27 audits, enabling them to manage compliance with the RCR’s Quality Standards for Imaging, accreditation for which was due in early 2025.

A clinical effectiveness lead monitored outcomes across locations. Imaging services performed well, such as with pregnancy questions asked before a scan (94% compliant against a target of 95%).

Care was based on up to date national and international guidance. Governance structures, staff training, and policies were underpinned with national updates to guidance.

Staff audited cross-site compliance with the 2024 IR(ME)R Schedule 2 employer’s procedures, which aimed to improve safety, and identified a need for more consistency in 2 measures. Senior staff worked with colleagues to implement change.

The service audited CT contrast extravasation, which is when contrast leaks from the vein. Staff scored 93% compliance in the most recent audit, reflecting good standards and a need for radiologist review for each patient.

Staff carried out ‘pause and check’ audits. ‘Pause and check’ is a national standard designed to ensure scan accuracy. The service scored 100% compliance. The service also scored 100% in the most recent MRI safe screening audit and in intravenous contrast audits.

Staff carried out peer reviews of a sample of scans to monitor quality. Results consistently exceeded the provider’s target.

The cross-site echocardiogram team had developed a quality framework, in line with British Society of Echocardiography (BSE) guidance. The service achieved 94% compliance. The team carried out joint reporting sessions to identify variances in interpretations between staff. The service was accredited by the BSE.

The service was multidisciplinary in nature and the imaging team worked with medical colleagues to deliver specialist care. For example, a cardiologist worked with the team to carry out stress profusion tests for patients fitted with a pacemaker and urology consultants worked closely with radiologists to diagnose and monitor treatment. Staff held scheduled multidisciplinary meetings with each medical specialty to coordinate care for patients with complex needs. A range of specialists joined meetings, supported by multidisciplinary coordinators. Staff offered an intraoperative MRI service collaboratively between surgeons, nurses, radiologists, physicists, and radiographers. Such multi-professional teamwork ensured the seamless integration of imaging into surgical procedures, enhancing precision and patient safety. Staff used the image exchange portal (IEP), a secure electronic system, to access previous scan images to aid diagnosis and treatment. Staff used the system to enable patients to move between services seamlessly and accelerate treatment decisions. The service had agreements with other providers in the event a patient could not be treated in this setting, including a rapid referral process to an oncology provider and to a mental health service. An MRI safety expert and a medical physics expert supported staff and carried out periodic reviews of practices and policies. The critical care unit had a CT scanner capable of brain scans, with on-call radiologists available at short notice. The service maintained a list of approved referrers. Approved referrer lists were in place for each modality, such as breast screening and DEXA (dual-energy X-ray absorptiometry) scans. DEXA is an imaging test for bone density. The audit programme was interdepartmental and interprofessional and staff participated in collaborative research projects and clinical trials across multiple disciplines. Such programmes focused on innovation in imaging techniques and technologies.

The imaging team provided a diagnostics service and treatment plans were led by medical professionals. As such there was limited scope for staff to provide health promotion interventions or advice. However, where this was possible, staff worked opportunistically. For example, they carried out age-specific pre-scan tests to ensure scans were appropriate and would meet the patient’s needs. If patients over 65 years old had not had a recent kidney function or blood glucose test, staff carried out a point of care test that provided results within 10 minutes. This met national RCR guidelines.

Staff were empowered to advocate for the role and value of radiography in healthcare and participated in public awareness and education campaigns through the provider’s community and marketing work. The work had a health promotion focus by providing details of how imaging could form part of regular health check-ups and long-term health improvement plans, such as echo stress tests or cardiac CT scans.

Imaging staff were involved in a research project exploring the impact of exercise on joint health. This was a multiorganisational project that aimed to improve health outcomes across imaging services.

Staff used a critical, urgent, and unexpected findings policy to guide the treatment of patients whose scans showed immediate or unexpected need. They called the original referrer and issued an alert on the electronic patient records system, which informed all staff involved in the patient’s care.

The critical results pathway standardised practice for all staff responsible for radiological imaging reports communication and meant action was taken quickly with the most relevant staff. The electronic record system tracked the whole process and included a trackable alert process so that senior staff had assurance results had been acted upon. This reduced the risk of serious harm to patients resulting from delayed action on significant imaging findings.

Staff reported on scan results within timeframes dictated by patient need. Targets, which staff consistently met, were 4 hours for an urgent scan, 24 hours for an inpatient scan, and 48 hours for an outpatient scan.

In the previous 12 months, staff peer reviewed an average of 4% of scan results each month. This figure was an average across all 3 sites. Used as a quality monitoring process, staff identified good practice in scans and areas for improvement or where a second opinion would benefit the patient’s outcomes. Peer review meant the service had assurance of consistent practice and as diagnostics staff worked across the provider’s 3 London sites, the 4% target meant peer reviews captured all staff in the service.

The consent process included a discussion of each patient’s medical history so that staff could identify risks or barriers to treatment. For example, some scans could not be carried out if a patient had certain kinds of implant and staff needed to know if they were fitted with a pacemaker. Staff were skilled in supporting patients in sensitive discussions, such as about the potential for pregnancy and dates of menstrual cycles, both of which could impact imaging.

We saw the consent process in practice during our onsite assessment. Staff gave patients time and space to ask questions and made sure they fully understood their planned imaging scans before proceeding. The provider’s policy required staff and patients to countersign an electronic consent form before treatment proceeded. While we saw staff complete this consistently in practice, compliance at a provider level demonstrated a need for improved consistency. For example, overall hospital compliance with consent requirements was 81%. The results reflected an audit across all institutes, including diagnostic imaging, and learning shared widely to embed consistent practice.