Improving Workflow Efficiency in Interventional Radiology

Late starts result in late finishes which creates inefficient workflow. The purpose of this quality-improvement project was to improve workflow efficiency in interventional radiology (IR) at the Central Arkansas Veterans Healthcare System. Six articles reviewed for this project demonstrated underlying problems with workflow efficiency in procedural areas that should be addressed. Interventions including checklists, facilitators, reminder e-mails to staff, requiring staff to come in earlier, and reporting arrival times of staff to supervisors helped improve on-time starts and workflow efficiency. A preimplementation and postimplementation retrospective chart review was used to evaluate this project. Random samples of 200 charts were reviewed before and after implementation, to establish the percentage of on-time starts. All patient satisfaction surveys received during the 4 months were reviewed for response to the item “My procedure began at the time it was scheduled.” Percentage of on-time starts and percentage of patients scoring “agree” or “strongly agree” on the satisfaction survey were compared before and after implementation. On-time starts increased from 29% and 24% in the 2 months before implementation to 34% and 40% in the 2 months after implementation. The item scored on the satisfaction survey increased from 73% and 83% before implementation and to 93% and 100% after implementation. In conclusion, a comprehensive checklist and increased physician reminders of first-case starts sent via e-mail helped to improve on-time starts in IR and increase patient satisfaction.     

Increasing On-Time Starts of Neurology Procedures in Interventional Radiology

The first scheduled surgical or diagnostic procedure of the day sets the tone for the entire daily operating room (OR) schedule. Delayed first procedures of the day result in subsequent delays, affecting productivity, staffing, and most importantly, patient care.Factors that impact the start of the first scheduled case, include late patient arrival, lack of staffing, and incomplete pertinent laboratory results. Subsequently, this may lead to cancelations and will directly affect the patient’s satisfaction with the process. Cases running in procedural rooms past their scheduled end times result in extra pay for staff, while canceled cases lead to lost revenue; these expenses are consequences of inefficiency. It is hard to determine the financial ramifications of late starts to an organization because overhead facility costs and staff salaries are multifactorial and specific to the setting. This quality improvement (QI) project evaluated the effectiveness of a change in shift start time for nurses as a solution to improving on-time starts by measuring first case on-time starts and the patient and radiology team satisfaction scores.     

Teamwork and Communication in Interventional Radiology

Teamwork and communication in the modern era are essential to the delivery of safe reliable patient care. As the complexity of the patient's disease entity increases and potential interventional procedures are warranted, consolidation of vast amounts of information from multiple teams is required. Thus, exceptional teamwork and communication are necessary for coordinated patient care. Breakdowns in teamwork and communication can lead to mistakes and breaches in patient safety. The purpose of this article is to review the fundamental principles and better understand the underlying reasons for dysfunctional teams and poor communication in the interventional radiology suite.     

The Role of Interventional Radiology in Trauma

Trauma is a leading and preventable cause of death in many age groups. Emergency care of trauma patients is complex and requires a team approach, which includes nurses and physicians. Interventional radiology (IR) plays a significant part in the management of some trauma patients with solid organ or pelvic injuries. This article reviews the role of IR and aspects of radiology nursing in this patient population.     

Implementation of Electronic Medical Record in Vascular and Interventional Radiology

This article discusses the implementation of a new electronic medical record (EMR) on workflow in vascular interventional radiology (VIR) and briefly discusses the preparation for launching EMR system, obstacles, advantages, and disadvantages based on an electronic survey of employees in the VIR unit at King Abdulaziz Medical City, Riyadh, Saudi Arabia. Launching the EMR system was preceded by 6-month period of a hospital-wide training introducing the new EMR system to all health care providers and associates. During this period, all hospital units were equipped with new computers, iPads, and special printers compatible with the new system. Integration of the radiology information system and new EMR was carefully conducted and monitored by the radiology team and new preprocedure and postprocedure order sets for every VIR procedure were uploaded to the system; these order sets helped in improving the quality of patient care and patient workflow in VIR. Intensive training of staff and “super users” was done in preparation for the actual launch of the system. On call clinical and information technology teams along with hotlines were available on the day of “Go Live” for troubleshooting.     

Acute Gastrointestinal Bleeding: The Role of Diagnostic and Interventional Radiology

The goal of this review article is to provide an overview to the initial management, classification, diagnosis, and treatment of acute gastrointestinal bleeding with emphasis on the use of radiology modalities and intervention. Special attention was placed on highlighting the nursing staff's imperative role during all phases of care in these cases.     

Issues in Managing Injured Adolescents in the Interventional Radiology Suite After Penetrating Trauma

Approximately 30 million emergency department (ED) visits are made by children each year in the United States and 90% of those visits are made to nonpediatric EDs. Adolescents progress from concrete to formal operational cognitive development but still lack the connectional thinking skills of adults. Injured adolescents who require diagnostic or therapeutic intervention in the IR suite as part of their peri-injury management present unique issues compared with similarly injured adults. An integrated and team-based approach to address such concerns in a pre-emptive fashion with a dedicated quality improvement program for continual refinement is recommended to enhance the likelihood of success and support patient-centered outcomes.     

Improving Throughput in Interventional Radiology: A Team Collaboration

The project purpose was to reduce patient throughput to 15:00 minutes or less once the patient arrived in interventional radiology (IR). Ishikawa (fishbone) diagram and Plan-Do-Study-Act test of change scientific methodology were used. Baseline data, specifically the time the patient arrived to the holding area to the time the patient was ready to begin the procedure was collected. Focus groups, through brainstorming, provided fishbone categories and causes leading to delayed throughput. Kotter's (2019) eight-step process of creating change was used to transform the team and execute the change. Over 10 months, between August 2017 and June 2018, data for start time were tracked for 1188 inpatients procedures and 1708 outpatient procedures. Overall time reduction from a mean time of 25:30 minutes to a mean of 15:00 minutes was achieved for all cases. A new model of care delivery realigned IR roles and created a structured process, improving interprofessional members' communication of pertinent patient safety information. Creating and implementing a new care delivery model based on interprofessional collaboration can be accomplished without increasing the number of physician providers, IR technologists, RNs, or support staff. The decreased throughput time was directly influenced by realigning staff roles and responsibilities and creation of the charge nurse role.     

Palliative Care and Interventional Radiology Interface to Improve Patient Outcomes

Interventional procedures benefit palliative care team patients in a variety of different ways, providing a means to manage a wide array of debilitating symptoms. The interprofessional collaboration of palliative care and interventional radiology is imperative for the successful management of chronically ill patients in their homes. This article briefly defines the roles of the palliative care team and that of interventional radiology in patient symptom management, providing a better understanding of the differences and the interface of these disciplines in the complex symptom management of palliative patients.     

The Role of Interventional Radiology in the Management of Acute Gastrointestinal Bleeding

This review article is intended to serve as an introductory reference to the clinical management of gastrointestinal bleeding (GIB) by interventional radiologists. This article focuses on the role of the nursing staff participating alongside the interventional radiologist in the patients' care. A discussion regarding presentation of GIB, workup, and postendoscopic role of interventional radiology (IR) is presented. Special emphasis is placed on the postprocedural care issues that are relevant specifically to nursing staff as they relate IR. Several sample cases are provided to illustrate common etiologies, presentations, and clinical management of GIB, with special emphasis on the role of IR.     

介入放射学在结直肠癌诊治中的应用

目的　探讨介入放射学在结直肠癌诊治中的价值。方法　４９ 例结直肠癌患者分别用ＤＳＡ 法进行了选择性动脉造影和区域化疗,对１ 例晚期直肠癌患者和１ 例直肠癌术后肝转移患者,留置了化疗泵（ＰＣＳ） 。结果　所有结直肠癌病灶在动脉造影时均明确显示,与手术符合率１００％ 。７ 例有不同程度肠梗阻的直肠癌患者,经动脉区域化疗后,６ 例症状得到改善。所有病例均无与插管有关的并发症。结论　介入放射学为结直肠癌的诊治提供了一条新的途径。     

Nurses' Experience of Caring for Patients in the Community After Discharge With an Interventional Radiology Drain in Ireland: A Qualitative Study

Interventional radiology (IR) is a rapidly expanding specialty within medicine. As a result, a new population of patients has emerged in Ireland; those discharged home with an IR drain for curative or preventative purposes requiring the care of nurses working in the community setting. The purpose of this study is to describe the experiences of nurses in the community caring for patients with an IR drain, with the objective of assisting in developing a new body of knowledge to enhance a patient's journey as they transition from an IR department to the community. The study is based on individual interviews analyzed using Colaizzi seven-step framework. Three themes emerged from the data findings: knowledge gap, information gap, and educational gap, whereby license professionals require additional education and training to care for this patient population. The study findings concluded that nurses in the community are unprepared to care for this patient cohort because of a knowledge deficit, inaccurate and poorly written discharge summaries, and a lack of education and training among nurses and patients regarding the intervention performed.     

Barriers to Informed Consent in Interventional Radiology: A Pilot Study

BackgroundInformed consent is a central part of the relationships between patients and interventional radiology teams, but consent practices are variable and limited.PurposeThis study explored consent practices among clinicians and staff in an academic IR department to identify barriers to informed consent.MethodsSystematic interviews were conducted with 17 clinicians and staff about their roles in obtaining informed consent, perceptions of what informed consent and capacity determinations entail, and barriers to patients’ understanding of IR procedures.FindingsResults revealed four key barriers to adequate informed consent: limited procedural experience/knowledge by the consenting clinician, unclear division of responsibilities, inconsistent approaches to assessing capacity and surrogate decision making, and wide variation in patients’ baseline understandings.DiscussionThis variation seemed to stem from a lack of shared understanding about consent processes and responsibilities, highlighting an important area for quality improvement in IR that would benefit from a larger multipractice investigation of consent practices.     

An Analysis of Nursing Diagnoses for Patients Undergoing Procedures in a Brazilian Interventional Radiology Suite

Innovations in minimally invasive surgery have led to more procedures being performed in the interventional radiology suite. It, therefore, is essential that nurses in radiology departments be competent to care for all types of patients. Use of nursing classification systems can improve care by providing standardized language for documentation. We conducted a project that involved 25 patients undergoing interventional radiology procedures between August and October 2006 in São Paulo, Brazil, to identify the most frequent North American Nursing Diagnosis Association (NANDA) nursing diagnoses used and then compared the NANDA diagnoses to Perioperative Nursing Data Set diagnoses. The most frequent nursing diagnoses in the participants were anxiety, chronic pain, inefficient tissue perfusion-peripheral, deficient knowledge, and risk for falls. These results are similar to diagnoses that have been reported in outpatient centers. The NANDA and Perioperative Nursing Data Set diagnoses were found to be similar.     

婴幼儿颈胸部淋巴管畸形的介入硬化治疗

目的探讨婴幼儿颈胸部淋巴管畸形介入硬化治疗的疗效及优点。方法回顾我院2013年10月~2015年12月共确诊治疗29例婴幼儿颈胸部淋巴管畸形的临床资料,男10例,女19例;年龄2个月~3岁,平均3个月龄,治疗前行超声、CT或MRI诊断为淋巴管畸形,并根据检查结果对淋巴管畸形予以分型,明确与周围血管及重要器官毗邻关系。术中抽取囊液为淡黄色或血色,注入平阳霉素(或博莱霉素),在DSA透视和/或超声引导下,使药物在瘤体内均匀的扩散,完成硬化治疗。术后1个月复查,并根据硬化效果决定是否行多次硬化治疗。结果介入硬化治疗小儿体表淋巴管畸形的总体有效率为100%。本组29例患儿,其中11例大囊型淋巴管畸形患儿行一次介入硬化治疗;13例患儿行两次介入硬化治疗;4例行三次介入硬化治疗,均达到治愈标准。1例行六次介入硬化治疗后瘤体缩小至30%,治疗有效。17例患儿术后局部肿胀,3例出现术后发热,分别给予对症处理。本组均未出现肺炎样病变和肺部纤维化严重不良反应。结论小儿颈胸部淋巴管畸形介入硬化治疗有效、安全,注射药物存留在囊腔内,术后药物持续作用于病灶时间长且并发症明显减少。     

Antibiotic stewardship programmes in intensive care units:Why,how,and where are they leading us

Antibiotic usage and increasing antimicrobial resistance(AMR) mount significant challenges to patient safety and management of the critically ill on intensive care units(ICU). Antibiotic stewardship programmes(ASPs) aim to optimise appropriate antibiotic treatment whilst minimising antibiotic resistance. Different models of ASP in intensive care setting, include "standard" control of antibiotic prescribing such as "de-escalation strategies"through to interventional approaches utilising biomarkerguided antibiotic prescribing. A systematic review of outcomes related studies for ASPs in an ICU setting was conducted. Forty three studies were identified from MEDLINE between 1996 and 2014. Of 34 nonprotocolised studies, [1 randomised control trial(RCT), 22 observational and 11 case series], 29(85%) were positive with respect to one or more outcome: These were the key outcome of reduced antibiotic use, or ICU length of stay, antibiotic resistance, or prescribing cost burden. Limitations of non-standard antibiotic initiation triggers, patient and antibiotic selection bias or baseline demographic variance were identified. All 9 protocolised studies were RCTs, of which 8 were procalcitonin(PCT) guided antibiotic stop/start interventions. Five studies addressed antibiotic escalation, 3 de-escalation and 1 addressed both. Six studies reported positive outcomes for reduced antibiotic use, ICU length of stay or antibiotic resistance. PCT based ASPs are effective as antibiotic-stop(de-escalation) triggers, but not as an escalation trigger alone. PCT has also been effective in reducing antibiotic usage without worsening morbidity or mortality in ventilator associated pulmonary infection. No study has demonstrated survival benefit of ASP. Ongoing challenges to infectious disease management, reported by the World Health Organisation global report 2014, are high AMR to newer antibiotics, and regional knowledge gaps in AMR surveillance. Improved AMR surveillance data, identifying core aspects of successful ASPs that are transferable, and further well-conducted trials will be necessary if ASPs are to be an effective platform for delivering desired patient outcomes and safety through best antibiotic policy.