Advertisement

Quality Assurance in Interventional Radiology: Preprocedural Care

  • Tarek JazmatiEmail author
  • Vishnu Chandra
  • Sohail Contractor
  • Hani Abujudeh
Quality and Safety (H Abujudeh, Section Editor)
  • 9 Downloads
Part of the following topical collections:
  1. Quality and Safety

Abstract

Purpose of Review

To review best practices to improve the quality of patient service in the field of interventional radiology prior to performing the procedure.

Recent Findings

We highlight a checklist of elements that have a potential for improvement and contribution to overall quality of patient care from the time of taking the consult, until the time of the procedure. Our check list includes establishing appropriateness of the procedure, reducing waiting times, patient-centered care, patient education, shared decision making, establishing expectations, informed consent, managing the patient’s medication list, preprocedure diet, prevention of CIN, prevention of contrast reactions, pain control and sedation, and coagulation status and hemostasis risk. Several consensus guidelines are referenced in this chapter. However, individual patients and clinical scenario vary and determine which guideline to follow or modify based in clinical judgment.

Summary

The clinic is a key component of success in any Interventional Radiology practice, as it provides the space for consultation, patient education, and preprocedural planning.

Keywords

Quality assurance Patient-centered care Interventional radiology clinic Patient education 

Notes

Acknowledgement

The authors would like to thank Dr. Ali N. Harb for reviewing their manuscript.

Compliance with Ethical Guidelines

Conflict of interest

Hani Abujudeh is a section editor for Current Radiology Reports. Tarek Jazmati, Vishnu Chandra, and Sohail Contractor each declare no potential conflicts of interest.

Human and Animal Rights and Informed Consent

This article does not contain any studies with human or animal subjects performed by any of the authors.

References

Recently published papers of particular interest have been highlighted as: • Of importance •• Of major importance

  1. 1.
    Harvey HB, et al. Key performance indicators in radiology: you can’t manage what you can’t measure. Curr Probl Diagn Radiol. 2016;45(2):115–21.  https://doi.org/10.1067/j.cpradiol.2015.07.014.CrossRefPubMedGoogle Scholar
  2. 2.
    Gunn A, Duncan J. Interventional radiology. In: Abujudeh HH, Bruno MA, editors. Radiology noninterpretive skills: the requisites ebook. Amsterdam: Elsevier Health Sciences; 2017.Google Scholar
  3. 3.
    Huynh TJ, et al. Abstract no. 101 The essential role of the interventional radiology consultation in day-to-day patient care. J Vasc Interv Radiol. 2009;20(2):S40.  https://doi.org/10.1016/j.jvir.2008.12.082.CrossRefGoogle Scholar
  4. 4.
    •• ACR appropriateness criterai. https://acsearch.acr.org/list. The ACR appropriateness criteria are major guidelines for imaging and procedural recommendations that Radiologists abide to during their practice.
  5. 5.
    Tjahjono D, Kahn CE Jr. Promoting the online use of radiology appropriateness criteria. Radiographics. 1999;19(6):1673–81.  https://doi.org/10.1148/radiographics.19.6.g99no301673.CrossRefPubMedGoogle Scholar
  6. 6.
    American College of Radiology, and Society of Interventional Radiology. Practice parameter for interventional clinical practice and management. J Vasc Interv Radiol. 2015;26(8):1197.  https://doi.org/10.1016/j.jvir.2015.05.017.CrossRefGoogle Scholar
  7. 7.
    Brady T, Castaneda F, Swischuk J, Smouse B. Re: the Legs for Life screening for peripheral vascular disease: compliance with physician recommendations in moderate- and high risk assessed patients. J Vasc Interv Radiol. 2001;12:774.CrossRefGoogle Scholar
  8. 8.
    Pollak JS, Rosenblatt M, Burdge C, Aruny J, Denbow N, Wysoki M. The interventional radiology clinic: changing practice patterns. J Vasc Interv Radiol. 2001;12(suppl):S66.Google Scholar
  9. 9.
    Obele CC, et al. What patients think about their interventional radiologists: assessment using a leading physician ratings website. J Am Coll Radiol. 2017;14(5):609–14.  https://doi.org/10.1016/j.jacr.2016.10.013.CrossRefPubMedGoogle Scholar
  10. 10.
    Dodd GD, Allen B, Birzniekc D, et al. Reengineering the radiology enterprise: a summary of the 2014 Intersociety Committee Summer Conference. J Am Coll Radiol. 2015;12:228–34.  https://doi.org/10.1016/j.jacr.2014.11.022.CrossRefPubMedGoogle Scholar
  11. 11.
    Shay W, et al. The effect of radiologist assistants in an interventional radiology department. Radiol Technol. 2017;88(3):333–8.PubMedPubMedCentralGoogle Scholar
  12. 12.
    Woods L. What works: scheduling—picture perfect solution. Health Manag Technol. 2001;22:48–50.PubMedGoogle Scholar
  13. 13.
    Mozumdar BC, Hornsby DN, Gogate AS, et al. Radiology scheduling: preferences of users of radiologic services and impact on referral base and extension. Acad Radiol. 2003;10:908–13.  https://doi.org/10.1016/s1076-6332(03)00002-3.CrossRefPubMedGoogle Scholar
  14. 14.
    Villarreal MC, et al. Improving procedure start times and decreasing delays in interventional radiology: a department’s quality improvement initiative. Acad Radiol. 2015;22(12):1579–86.  https://doi.org/10.1016/j.acra.2015.08.008.CrossRefPubMedGoogle Scholar
  15. 15.
    Goodman BS, et al. Improving the efficiency of an interventional radiology consultation service. J Vasc Interv Radiol. 2014;25(3):S60.  https://doi.org/10.1016/j.jvir.2013.12.150.CrossRefGoogle Scholar
  16. 16.
    Abujudeh H, et al. Key principles in quality and safety in radiology. Am J Roentgenol. 2017;208(3):W101–9.  https://doi.org/10.1067/j.cpradiol.2015.07.014.CrossRefGoogle Scholar
  17. 17.
    Specht K, Abujudeh H, Salazar GM. Qualitative analysis of patients’ complaints and their resolution in interventional radiology (IR): 12-year experience at an academic medical center. J Vasc Interv Radiol. 2014;3(25):S101–2.  https://doi.org/10.1016/j.jvir.2013.12.284.CrossRefGoogle Scholar
  18. 18.
    Wachter RM. How measurement fails doctors and teachers. New York Times website. www.nytimes.com/2016/01/17/opinion/Sunday/how-measurement-fails-doctors-and-teachers.html?_r = 0. Accessed 1 Apr 2016.
  19. 19.
    Abujudeh HH, Danielson A, Bruno MA. A patient-centered radiology quality process map: opportunities and solutions. Am J Roentgenol. 2016;207(5):940–6.CrossRefGoogle Scholar
  20. 20.
    Salazar GM, Burk KS, Abujudeh H. Patient complaints in image-guided interventions: evaluation of multifactorial issues using a coding taxonomy. Am J Roentgenol. 2018.  https://doi.org/10.2214/ajr.17.19104.CrossRefGoogle Scholar
  21. 21.
    Ripley BA, Tiffany D, Lehmann LS, Silverman SG. Improving the informed consent conversation: a standardized checklist that is patient centered, quality driven, and legally sound. J Vasc Interv Radiol. 2015;26:1639–46.  https://doi.org/10.1016/j.jvir.2015.06.007.CrossRefPubMedGoogle Scholar
  22. 22.
    Qureshi AI, Gilani S, Adil MM, et al. Pattern of informed consent acquisition in patients undergoing emergent endovascular treatment for acute ischemic stroke. J Vasc Interv Neurol. 2014;7:21–5.PubMedPubMedCentralGoogle Scholar
  23. 23.
    Nielsen-Bohlman L, Panzer AM, Kindig DA. Ex-ecutive summary. In: Health literacy: a prescription to end confusion. Washington, DC: National Academies Press; 2004. p. 1–18.Google Scholar
  24. 24.
    Bass PF, Wilson JF, Griffith CH, Barnett DR. Residents’ ability to identify patients with poor literacy skills. Acad Med. 2002;77:1039–41.  https://doi.org/10.1097/acm.0000000000002350.CrossRefPubMedGoogle Scholar
  25. 25.
    Parikh NS, Parker RM, Nurss JR, Baker DW, Williams MV. Shame and health literacy: the unspoken connection. Patient Educ Couns. 1996;27:33–9.  https://doi.org/10.1016/0738-3991(95)00787-3.CrossRefPubMedGoogle Scholar
  26. 26.
    Bernat JL, Peterson LM. Patient-centered in-formed consent in surgical practice. Arch Surg. 2006;141:86–92.  https://doi.org/10.1001/archsurg.141.1.86.CrossRefPubMedGoogle Scholar
  27. 27.
    ACR–SIR–SPR practice parameter on informed consent for image-guided procedures. https://www.acr.org/-/media/ACR/Files/Practice-Parameters/InformedConsent-ImagGuided.pdf.
  28. 28.
    Pass SE, Simpson RW. Discontinuation and reinstitution of medications during the perioperative period. Am J Health Syst Pharm. 2004;61(9):899–912.PubMedGoogle Scholar
  29. 29.
    • Taslakian B, Sebaaly MG, Al-Kutoubi A. Patient evaluation and preparation in vascular and interventional radiology: what every interventional radiologist should know (part 2: patient preparation and medications). Cardiovasc Interv Radiol. 2016;39(4):489–99.  https://doi.org/10.1007/s00270-015-1239-4. Important source for evidence based strategies that improve quality of patient care before the interventional procedure.
  30. 30.
    American Society of Anesthesiologists Committee. Practice guidelines for preoperative fasting and the use of pharmacologic agents to reduce the risk of pulmonary aspiration: application to healthy patients undergoing elective procedures: an updated report by the American Society of Anesthesiologists Committee on Standards and Practice Parameters. Anesthesiology. 2011;114(3):495–511.  https://doi.org/10.1097/aln.0b013e3181fcbfd9.CrossRefGoogle Scholar
  31. 31.
    American Society of Anesthesiologists Task Force on Sedation, Analgesia by Non-Anesthesiologists. Practice guidelines for sedation and analgesia by non-anesthesiologists. Anesthesiology. 2002;96(4):1004–17.  https://doi.org/10.1097/aln.0000000000002043.CrossRefGoogle Scholar
  32. 32.
    Moran TC, Kaye AD, Mai AH, Bok LR. Sedation, analgesia, and local anesthesia: a review for general and interventional radiologists. Radiographics. 2013;33(2):E47–60.  https://doi.org/10.1148/rg.332125012.CrossRefPubMedGoogle Scholar
  33. 33.
    American College of Radiology. ACR manual on contrast media. Reston: American College of Radiology; 2012.  https://doi.org/10.1016/j.mehy.2018.07.030.CrossRefGoogle Scholar
  34. 34.
    Pucelikova T, Dangas G, Mehran R. Contrast-induced nephropathy. Catheter Cardiovasc Interv. 2008;71(1):62–72.  https://doi.org/10.1002/ccd.21207.CrossRefPubMedGoogle Scholar
  35. 35.
    Davenport MS, Cohan RH, Ellis JH. Contrast media controversiesin 2015: imaging patients with renal impairment or risk of contrast reaction. Am J Roentgenol. 2015;204(6):1174–81.  https://doi.org/10.2214/ajr.14.14259.CrossRefGoogle Scholar
  36. 36.
    Katzberg RW, Newhouse JH. Intravenous contrast medium-induced nephrotoxicity: is the medical risk really as great as we have come to believe? Radiology. 2010;256(1):21–8.  https://doi.org/10.1148/radiol.1009200.CrossRefPubMedGoogle Scholar
  37. 37.
    Gleeson TG, Bulugahapitiya S. Contrast-induced nephropathy. Am J Roentgenol. 2004;183(6):1673–89.  https://doi.org/10.2214/ajr.183.6.01831673.CrossRefGoogle Scholar
  38. 38.
    Andreucci M, Solomon R, Tasanarong A. Side effects of radiographic contrast media: pathogenesis, risk factors, and prevention. BioMed Res Int. 2014.  https://doi.org/10.1155/2014/741018.741018.CrossRefPubMedPubMedCentralGoogle Scholar
  39. 39.
    Andreucci M, et al. Prevention of contrast-induced nephropathy through a knowledge of its pathogenesis and risk factors. Sci World J. 2014.  https://doi.org/10.1155/2014/823169.CrossRefGoogle Scholar
  40. 40.
    Ball T, McCullough PA. Statins for the prevention of contrast-induced acute kidney injury. Nephron Clin Pract. 2014;127(1-4):165–71.  https://doi.org/10.1159/000363202.CrossRefPubMedGoogle Scholar
  41. 41.
    Solomon RJ, Natarajan MK, Doucet S, Sharma SK, Staniloae CS, Katholi RE, Gelormini JL, Labinaz M, Moreyra AE. Cardiac angiography in renally impaired patients (CARE) study: a randomized double-blind trial of contrast-induced nephropathy in patients with chronic kidney disease. Circulation. 2007;115(25):3189–96.  https://doi.org/10.1161/circulationaha.106.671644.CrossRefPubMedGoogle Scholar
  42. 42.
    Bush WH Jr, Krecke KN, King BF Jr, et al. Radiology life support. New York: Oxford University Press; 1999.  https://doi.org/10.2214/ajr.08.1542.CrossRefGoogle Scholar
  43. 43.
    Mueller PR, Biswal S, Halpern EF, Kaufman JA, Lee MJ. Interventional radiologic procedures: patient anxiety, perception or pain, understanding of procedure, and satisfaction with medication—a prospective study. Radiology. 2000;215:684–8.  https://doi.org/10.1148/radiology.215.3.r00jn33684.CrossRefPubMedGoogle Scholar
  44. 44.
    •• Patel IJ, et al. Consensus guidelines for periprocedural management of coagulation status and hemostasis risk in percutaneous image-guided interventions. J Vasc Interv Radiol. 2012;23:727. Imporant guidelines for anti-coagulation before interventional procedures.Google Scholar

Copyright information

© Springer Science+Business Media, LLC, part of Springer Nature 2019

Authors and Affiliations

  • Tarek Jazmati
    • 1
    Email author
  • Vishnu Chandra
    • 1
  • Sohail Contractor
    • 1
  • Hani Abujudeh
    • 1
  1. 1.Rutgers New Jersey School of MedicineNewarkUSA

Personalised recommendations