Infection Control in Interventional Radiology During the COVID-19 Era.

The COVID-19 pandemic has challenged the capacity of interventional radiology departments worldwide to effectively treat COVID-19 and non-COVID-19 patients while preventing disease transmission among patients and healthcare workers. In this review, we describe the various data driven infection control measures implemented by the interventional radiology department of a large tertiary care center in the United States including the use and novel re-use of personal protective equipment, COVID-19 testing strategies, modifications in procedural workflows and the leveraging of telehealth visits. Herein, we provide effective triage, procedural, and management algorithms that may guide other interventional radiology departments during the ongoing COVID-19 pandemic and in future infectious disease outbreaks.

Radiation Dose Monitoring for Fluoroscopically Guided Interventional Procedures: Effect on Patient Radiation Exposure.

Purpose To analyze the clinical effect of continuous dose monitoring and patient follow-up for fluoroscopically guided vascular interventional procedures over 8 years. Materials and Methods In this retrospective study, an in-house semiautomated system was developed for fluoroscopic dose monitoring. The quarterly number of procedures from January 2010 to December 2017 was analyzed with count time series to estimate quarterly change rate. Technologists recorded four dose surrogates in custom fields of institutional dictation software through a Web interface. Radiation doses were transferred automatically to the radiology report and a centralized dose database when the radiologist initiated procedure dictation. A medical physicist reported weekly on procedures with air kerma at the reference point (Ka,r) of 2 Gy or higher to a division-designated radiologist and hospital radiation safety committee who required the attending radiologist to set up follow-up appointments for patients who underwent procedures with a Ka,r greater than or equal to 5 Gy. Results There were a total of 41 585 procedures; 1553 (3.7%) procedures had a Ka,r of 2-5 Gy. Among 240 procedures with Ka,r greater than 5 Gy, 22 had Ka,r greater than 9 Gy. The percentage of high Ka,r procedures decreased over time, going from 5.9% in 2010 to 2.0% in 2017 for procedures with Ka,r of 2-5 Gy and from 1.0% in 2010 to 0.13% in 2017 for procedures with Ka,r greater than or equal to 5 Gy. Relative reduction per quarter was approximately 2.7% (95% confidence interval: 1.5%, 3.8%) for Ka,r of 2-5 Gy and 4.5% (95% confidence interval: 1.5%, 7.6%) for Ka,r greater than or equal to 5 Gy. Conclusion Eight-year temporal trends show three- to eightfold reduction in the number of high-dose procedures. © RSNA, 2019 Online supplemental material is available for this article. See also the editorial by Balter in this issue.

Sedation shared decision-making in ambulatory venous access device placement: Effects on patient choice, satisfaction and recovery time.

This study was undertaken to determine the impact of shared decision-making when selecting a sedation option, from no sedation (local anesthetic), minimal sedation (anxiolysis with a benzodiazepine) or moderate sedation (benzodiazepine and opiate), for venous access device placement (port-a-cath and tunneled catheters) on patient choice, satisfaction and recovery time. This is an IRB-approved, HIPPA-compliant, retrospective study of 198 patients (18-85 years old, 60% female) presenting to an ambulatory vascular interventional radiology department for venous access device placement between 22 October 2014 and 7 October 2015. Patients were educated about sedation options and given the choice of undergoing the procedure with no sedation (local anesthetic only), or minimal or moderate sedation. Satisfaction was assessed through three survey questions. No sedation was selected by 53/198 (27%), minimal sedation by 71/198 (36%) and moderate sedation by 74/198 (37%). All subjects would recommend the option to another patient and valued the opportunity to select a sedation option. Post-procedure recovery time differences were statistically significant (p<0.0001) with median recovery times of 0 minutes for no sedation, 38 minutes for minimal sedation and 64 minutes for moderate sedation. In conclusion, patient sedation preference for venous access device placement is variable, signifying there is a role for shared decision-making as it empowers the patient to select the option most aligned with his or her goals. The procedure is well-tolerated, associated with high satisfaction, and the impact on departmental flow is notable because patients choosing no or minimal sedation results in a decreased post-procedure recovery time burden.

Revenue Potential for Inpatient IR Consultation Services: A Financial Model.

PURPOSE: Interventional radiology (IR) has historically failed to fully capture the value of evaluation and management services in the inpatient setting. Understanding financial benefits of a formally incorporated billing discipline may yield meaningful insights for interventional practices. MATERIALS AND METHODS: A revenue modeling tool was created deploying standard financial modeling techniques, including sensitivity and scenario analyses. Sensitivity analysis calculates revenue fluctuation related to dynamic adjustment of discrete variables. In scenario analysis, possible future scenarios as well as revenue potential of different-size clinical practices are modeled. RESULTS: Assuming a hypothetical inpatient IR consultation service with a daily patient census of 35 patients and two new consults per day, the model estimates annual charges of $2.3 million and collected revenue of $390,000. Revenues are most sensitive to provider billing documentation rates and patient volume. A range of realistic scenarios-from cautious to optimistic-results in a range of annual charges of $1.8 million to $2.7 million and a collected revenue range of $241,000 to $601,000. Even a small practice with a daily patient census of 5 and 0.20 new consults per day may expect annual charges of $320,000 and collected revenue of $55,000. CONCLUSIONS: A financial revenue modeling tool is a powerful adjunct in understanding economics of an inpatient IR consultation service. Sensitivity and scenario analyses demonstrate a wide range of revenue potential and uncover levers for financial optimization.

An overview of clinical associate roles in the neurointerventional specialty.

Neurointerventionalists have long partnered with certain types of clinical associates to provide longitudinal care. This overview summarizes differences in education, background, roles, and scopes of practice of the various clinical associates (physician assistants, nurse practitioners, clinical nurse specialists, radiology practitioner assistants, radiologist assistants, and nursing care coordinators). Key differences and similarities are highlighted to alleviate confusion about the roles clinical associates can assume on a neurointerventional service. This overview is intended to guide practices as they consider broadening their clinical support teams.

Team training: a safer future for neurointerventional practice.

As medical errors and patient harm mount in today's healthcare arena, healthcare administrators have turned to high efficiency, high reliability, and high risk industries for strategies and guidance. By adopting elements of Crew Resource Management (CRM), healthcare teams have been shown to work more effectively together, allowing for earlier recognition of medical errors and catching them before they cause serious patient harm.

Radiofrequency identification for inventory in neurointerventional practice.

Implementations of radiofrequency identification (RFID) systems within hospital settings are not unique or without controversy. To date, little consideration has been given to use of this technology in clinical interventional radiologic practice. The potential financial advantages coupled with benefits to quality and safety and increases in staff satisfaction are considerable. The authors outline these advantages by enabling readers to broadly consider the systemic perspective of implementing RFID technology with an associated vision toward downstream growth. Furthermore, the authors demonstrate the benefits of RFID technology integration in reducing cost and increasing quality assurance and the on-time delivery of services. Implementing RFID requires commitment from frontline technologist staff members to work collaboratively with management and external vendors. Ultimately, the authors believe this technology can positively influence patient care.

Establishing operational stability--developing human infrastructure.

Over the past year, Toyota has come under harsh scrutiny as a result of several recalls. These well publicized mishaps have not only done damage to Toyota's otherwise sterling reputation for quality but have also called into question the assertions from a phalanx of followers that Toyota's production system (generically referred to as TPS or Lean) is the best method by which to structure one's systems of operation. In this article, we discuss how Toyota, faced with the pressure to grow its business, did not appropriately cadence this growth with the continued development and maintenance of the process capabilities (vis a vis the development of human infrastructure) needed to adequately support that growth. We draw parallels between the pressure Toyota faced to grow its business and the pressure neurointerventional practices face to grow theirs, and offer a methodology to support that growth without sacrificing quality.