Interventional radiology workflow and hospital occupancy in the pandemic era: areas for improvement

ABSTRACT

Purpose: Throughout the COVID-19 pandemic, an increasing hospital occupancy rate has been an ongoing issue, with several hospitals operating at or near full capacity. Emphasis has been placed to improve discharge strategies to maintain bed space and decrease hospital occupancy rate. The interventional radiology (IR) department can play a pivotal role in the discharge process by providing timely interventions that are essential prior to a patient’s discharge. This project aims to define the time intervals between the date of priority request for an IR procedure (in preparation to discharge), date of IR procedure, and date of patient’s actual discharge. Materials and Methods: Between April–September of 2021, a retrospective review of hospitalized patients in a tertiary medical center for whom an IR procedure labeled as “Priority Discharge” was requested by primary teams was performed. Multiple procedure-related variables, including time intervals between the placement of the order, and the patient’s actual discharge were recorded. Results: During the study period, a total of 75 IR procedure requests (42 male, 33 female, mean age of 60y, range 21-98y) were labeled as “Priority Discharge.” Overall 74 of 75 (99%) procedures were completed on the same day of request. Performed procedures were peripherally inserted catheter (51%) midline (24%), tunneled hemodialysis catheter (16%), and other (9%). The average time interval that patients stayed in the hospital after the IR procedure was 3 days (SD 4, Range of 0-20 days). Of the total 75 patients, 23 (31%) patients were discharged on the same day as the procedure, 33 (44%) patients were discharged within 1-4 days after the procedure, 12 (16%) patients were discharged within 5-9 days after the procedure, and 7 (9%) patients were discharged 10 or more days after the procedure. The average admission duration for the study population was 10 d (range 2-33 d). Conclusion: Due to the inherent complexity of the hospital operations, strategies aiming to prioritize IR procedures for patients pending discharge could help to improve hospitals’ occupancy rates. Nevertheless as shown in our study a considerable percent of these patients stay in hospital for several days after the procedure is complete. Inefficient application of this system could disrupt the triage of the requested procedures, which may eventually lead to an unnecessary delay for other patients and prolong their hospitalization. Accordingly, tools should be incorporated into these strategies that could improve IR workflow and decrease susceptibility of these strategies to miscommunication and errors.