Provision of out-of-hours interventional radiology services in Scotland

Trends and implications of 24/7 interventional radiology in a newly opened acute hospital

Introduction

We aim to evaluate the frequency of use and changing practices for all out-of-hours interventional radiology (IR) procedures performed in a new hospital.

Methods

This is a 5 year retrospective review of all out-of-hours procedures performed by the Interventional Radiology team from July 2010 to June 2015. Number and category of procedures performed were identified from the RIS database.

Results

Of the 7140 procedures performed by IR over the 5 years, 764 were out-of-hours. The total number of out-of-hours cases performed annually by IR has increased by 240% from year 1 to year 5. The variety and distribution of out-of-hours work has shown a characteristic trend with rising requests for advanced procedures such as active haemorrhage control.

Conclusion

The rising number and complexity of cases for on-call IR further supports the need for a formal on-call rota, ideally 1:6, to provide a sustainable 24/7 service and optimize patient outcome in an acute hospital.

A survey of nurse staffing levels in interventional radiology units throughout the UK

AIM

To supplement previous surveys analysing provision of interventional radiology (IR), in-hours (IH) and out-of-hours (OOH), by specifically surveying the level of nursing support provided.

MATERIALS AND METHODS

A web-based questionnaire was distributed to all British Society of Interventional Radiology (BSIR) members. This addressed several aspects of radiology nursing support for IR procedures, both IH and OOH.

RESULTS

Sixty percent of respondents indicated that they have a formal OOH service. Of these, all have a dedicated nursing rota, with the vast majority operating with one nurse. IH, 77% of respondents always have a scrubbed nurse assistant, but this reduces to 40% OOH. IH, 4% never have a scrubbed radiology nurse assistant, which rises to 25% OOH. IH, 75% of respondents always have a radiology nurse dedicated to patient monitoring, but this reduces to 20% OOH. IH, 3% never have a radiology nurse dedicated to patient monitoring, which rises to 42% OOH.

CONCLUSION

A significant disparity exists in the level of IR nursing support between IH and OOH. The majority of sites provide a single nurse with ad hoc additional support. This is potentially putting patients at increased risk. Radiology nurses are integral to the safe and sustainable provision of IR OOH services and a greater focus is required to ensure adequate and safe staffing levels for 24/7 IR services.

Mortality reporting in interventional radiology: experience of a pilot audit with the Scottish Audit of Surgical Mortality

AIM

To describe the initial pilot phase of the 2009 Scottish Audit of Surgical Mortality (SASM), which includes outcomes and difficulties that arose during any interventional radiology (IR) procedure performed on patients in this audit over an 18 month period.

MATERIALS AND METHODS

Approximately 40 consultant interventional radiologists from all units in Scotland elected to participate in the audit. Each response was then peer reviewed after anonymisation of the patient and institution. If a relevant ACON (area for consideration or area of concern) was generated, this was checked by one of the other reviewers before communication with the original reporting radiologist and colleagues. There was then a right of reply by the reporting unit before formal documentation was sent out.

RESULTS

Initial results were analysed after 18 months period, during which time 95 forms relating to deaths of surgical inpatients were sent to interventional radiologists identified as having been involved in an IR procedure at some time during the patient's admission. Seventy-one forms had been returned by July 2010, of which 46 had gone through the entire SASM process. From these, 10 ACONs were attributed. Anonymised case vignettes and reports from these were used as educational tools.

CONCLUSION

Involvement with SASM is a useful process. Significant safety issues and learning points were identified in the pilot. The majority of ACONs identified by the audit were in patients who had undergone percutaneous biliary interventions.