In a paper published last month in the journal CardioVascular and Interventional Radiology (CVIR), Matthew Lukies and colleagues from Alfred Health in Melbourne, Australia have released data collected from their institution giving visibility to the clinical interventional radiology (IR) service that they state has gone largely unnoticed. As IR has not yet achieved formal distinct speciality status in Australia or New Zealand, the authors sought to show IR’s increasing self-governance independent from diagnostic radiology (DR).
The authors write that providing optimal care for patients in IR is dependent on interventional radiologists’ adoption of clinical responsibility—from referral and clinical assessment, through to treatment, and follow-up care. Lukies et al state that clinical practice in IR enables the provision of a comprehensive service, helping to develop a “robust referral pathway” and provide optimal care for patients. They believe this keeps IR “relevant and competitive” among other interventional specialties who are performing endovascular and minimally invasive procedures.
Lukies and colleagues detail that the strategic direction of IR and DR have “diverged” in the recent past and note that the output of DR is increasingly benchmarked via relative value units and other metrics. Without distinct specialty status away from DR, IR sits within these datasets, they state, operating via an ancillary ‘service provision’ structure which has created “inherent problems for interventional radiologists”. This is partly due to the fact that the clinical aspects of IR work, which include ward rounds, ward consultations, preadmission assessments, and outpatient appointments, are not captured in traditional DR key performance metrics.
This has led to a perceived “imbalance” in work output between IR and DR, Lukies and colleague state, resulting in interventional radiologists feeling “pressured” to achieve particular levels of diagnostic output to the detriment of clinical IR practice.
To capture their own data to measure clinical IR output, Lukies et al created a searchable tag within their inpatient ward round and electronic medical record consultation notes. This tag could then be measured over a given time period and collated as a ‘clinical IR’ key performance indicator.
A ward consultation constituted a face-to-face, bedside review of an inpatient by one or more members of the IR team (consultant, fellow, and intern) including ward rounds and consultation referrals. Excluded from this data collection were outpatient clinic reviews, phone consults to patients or family members and discussions with other specialities regarding patients.
Between April and July 2024, the authors write that their IR service provided a total of 394 inpatient consultations—a mean of 4.7 ward consultations per day. They describe that their service is typically comprised of two to four interventional radiologists and one advanced training fellow each day. They utilise three angiography suites, and deal with admissions, discharges, referrals and consultations, as well as twice weekly outpatient clinics.
The authors presented these data to their DR colleagues—including direct managers—who were unaware that this work takes place. They stated, however, that they were appreciative of its “value in audit and role in governance changes for optimal patient care”.
Demonstrable of the importance of measuring clinical care in IR, Lukies et al write that giving visibility to the day-to-day workload of interventional radiologists outside of DR’s metrics is “critical” in providing optimal care and initiating workforce planning for the future. They state that the promotion of their clinical work through distinct performance indicators is an important component in assessing and thereby resourcing IR services.
“Clinical practice is the cornerstone of modern IR, and we must be provided with sufficient time, resources and workforce to ensure safe and high-quality clinical care for our patients,” Lukies and the research team add.
