The study reports on the evolution of the Australian radiologist relative value unit (RVU) model of measuring radiologist reporting workloads in teaching hospital departments, and aims to outline a way forward for the development of a broad national safety, quality and performance framework that enables value mapping, measurement and benchmarking. The Radiology International Benchmarking Project of Queensland Health provided a suitable high-level national forum where the existing Pitman-Jones RVU model was applied to contemporaneous data, and its shortcomings and potential avenues for future development were analysed. Application of the Pitman-Jones model to Queensland data and also a Victorian benchmark showed that the original recommendation of 40,000 crude RVU per full-time equivalent consultant radiologist (97-98 baseline level) has risen only moderately, to now lie around 45,000 crude RVU/full-time equivalent. Notwithstanding this, the model has a number of weaknesses and is becoming outdated, as it cannot capture newer time-consuming examinations particularly in CT. A significant re-evaluation of the value of medical imaging is required, and is now occurring. We must rethink how we measure, benchmark, display and continually improve medical imaging safety, quality and performance, throughout the imaging care cycle and beyond. It will be necessary to ensure alignment with patient needs, as well as clinical and organisational objectives. Clear recommendations for the development of an updated national reporting workload RVU system are available, and an opportunity now exists for developing a much broader national model. A more sophisticated and balanced multidimensional safety, quality and performance framework that enables measurement and benchmarking of all important elements of health-care service is needed.

The latex allergy pathway provides a guide for training and development of services to facilitate improvements in delivery as close to the patients home as possible. The authors recommend that this pathway is implemented locally by a multidisciplinary team with a focus on creating networks between primary, secondary and tertiary care to improve services for children with allergic conditions.

AimsThe Royal College of Paediatrics and Child Health has been commissioned by the Department of Health to develop national care pathways for children with allergies. The aim of the current project was to develop a national care pathway for children with anaphylaxis. The pathway focuses on standardising the level of care received by children with allergic conditions and defining the competences required to provide a high-quality service.MethodThe pathway was developed by the consensus of a multidisciplinary working group based on a systematic review of evidence from the Cochrane Library, Medline, the National Guidelines Clearing House, the Scottish Intercollegiate Network and the National Institute for Clinical Excellence. The pathway was then reviewed by a broad group of stakeholders including the public.ResultsThe results are presented in three sections: a pathway algorithm, the competences required to deliver the pathway and evidence-based recommendations. The principal points of pathway entry are defined and the ideal pathway of care is described in discrete stages from self-care through to follow-up.For each stage of the pathway, competences in the three main categories were identified: ▸ the things a health professional should know▸ the specific skills expected of a health professional▸ the services or facilities to which the health professional should have access. The review of the evidence in relation to children with anaphylaxis identified four key evidence-based recommendations.ConclusionThe authors have produced a national care pathway for anaphylaxis based on an evidence review, expert consensus and stakeholder input. The authors recommend that this pathway is implemented locally by multidisciplinary care teams with a focus on creating networks between primary, secondary and tertiary care to improve services for children with allergic conditions. The intention is that the use of this tool together with audit to ensure continuous improvement in the national delivery of services for children with anaphylaxis.