Interventional radiology on the frontlines in 2021: Rising to the challenges ahead

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radiology
Narayan Karunanithy

Following the rapid reconfiguration of healthcare practices in response to the COVID-19 pandemic in early 2020, Narayan Karunanithy reflects on the position of interventional radiology (IR) services going into 2021. Citing data demonstrating that the reduction in IR activity during the first national lockdown was far less than that seen in other procedure-centred specialties, such as vascular surgery, urology, and endoscopy, Karunanithy argues that formal incorporation of IR treatments into patient pathways would result in more efficient care. As many IR procedures can be performed as a day case or in an ambulatory care unit, he writes that interventional radiologists can “hugely support emergency preparedness plans”, which will likely continue to be vital in 2021.

The challenge for healthcare organisations to deliver on the “triple aims” of health system performance has been made many magnitudes more complex in 2020 due to the COVID-19 pandemic (see Table 1).1 The scope and nature of interventional radiology (IR) practice, however, is unusually well-placed to meet these aims, and looks well set to play a more central role in delivery of high quality, safe healthcare in 2021 and beyond.

radiology
Table 1: The triple aims of healthcare

At the time of writing, we find ourselves in the midst of the second COVID-19 pandemic wave in the UK, and sadly we are once again already seeing both high infection and mortality rates. The recent promising vaccine results have provided a much-needed glimmer of hope. Whilst vaccines are considered at present our best hope, uncertainty still remains regarding the effectiveness, availability, and impact of those vaccines. Hence, the healthcare strategy—at least for the foreseeable future—will need to incorporate the ability to treat those with COVID-19 and continue to provide timely, safe, effective, and cost-efficient care for everyone with non-COVID related illnesses.

During the first wave, it was impressive and inspiring to see so many IR departments demonstrate a willingness to reconfigure working practice and be available to provide much-needed acute services. One of the models that worked extremely well during the summer/autumn of 2020 was the spatial segregation of services into “low-risk” and “high-risk” sites. This was, in large part, created through partnerships forged with private sector hospitals which enabled IR to maintain access to important treatments such as tumour ablation and uterine fibroid and prostate artery embolization in “low-risk” environments. In parallel, comprehensive cover was provided at “hot” sites for the spectrum of COVID and non-COVID emergencies like embolization, thrombectomy, complex venous access, and percutaneous drainage of obstructed kidneys, bile ducts, and abscesses.2 Published activity data bear this out and have shown that the reduction in IR activity during the first wave of lockdown, by 41% and 25% in outpatient and inpatient volumes respectively, was far less than that seen in other procedure-centred specialties like vascular surgery, urology, and endoscopy.3

Even prior to the pandemic, it was estimated that approximately one in 10 in-patients were treated by IR during their hospital stay, underlining the key importance of IR in the day-to-day functioning of hospitals.4 Formal incorporation of IR treatments into patient pathways and access to IR expertise through ward rounds and clinics would allow far more efficient and streamlined care for those requiring it. Across the spectrum of clinical practice, minimally invasive IR treatments result in quicker recovery, lower morbidity, and shorter hospital stays. Crucially in these times, these procedures can often be performed in a day case or ambulatory care unit. The availability of such units can hugely support emergency preparedness plans. This was illustrated in the first wave of the pandemic, when most endoscopy services ceased and IR stepped in to perform many more radiologically inserted gastrostomies rather than percutaneous endoscopic gastrostomies.

An additional benefit of high-volume IR day case units is the efficient utilisation of resources and an increase in financial income for the organisation. Increasingly, organisations within the UK have come to recognise these clinical and financial benefits, and many centres have invested in such facilities. However, these are not universally available, as highlighted in the recently published Radiology GIRFT [Get It Right First Time] report.5 Alongside this, there is a need for robust workforce planning to ensure there are adequate numbers of IR doctors, nurses, radiographers, and administrative staff to sustain IR services. The skillset that IR staff possess is extremely versatile, and there were many reports of IR supporting the frontline response during the first wave of the pandemic. This included redeploying staff in the critical care setting with the goal of providing bed-side procedures like difficult venous access and ultrasound guided drainage procedures.

Whilst the months ahead will be challenging, there is an opportunity to establish IR practice firmly at the very core of clinical practice through proactive planning and delivery of innovative, effective, and safe care for the benefit of our patients.

I would like to acknowledge the guidance and support from Ian McCafferty (President, British Society of Interventional Radiology [BSIR]) in the preparation of this article.

Stay safe everyone.

Narayan Karunanithy is a member of the Communications Committee, British Society of Interventional Radiology, and is a consultant interventional radiologist at Guy’s & St Thomas’ NHS Foundation Trust, London, UK.

References

  1. Institute for Healthcare Improvement Triple Aim Initiative, http://www.ihi.org/Engage/Initiatives/TripleAim/Pages/default.aspx
  2. Pendower L, Benedetti G, Breen K, Karunanithy N. Catheter-directed thrombolysis to treat acute pulmonary thrombosis in a patient with COVID-19 pneumonia. BMJ Case Rep. 2020 Aug 11;13(8):e237046
  3. Hashmi A, Parikh K, Al-Natour M et al. Interventional radiology procedural volume changes during COVID-19 initial phase: A tertiary level Midwest health system experience. Clin Imaging. 2020 Nov 10;72:31–36
  4. Shah SS, Tennakoon L, O’Beirne E, Staudenmayer KL, Kothary N. The Economic Footprint of Interventional Radiology in the United States: Implications for Systems Development. J Am Coll Radiol. 2020 Sep 9:S1546–1440(20)30873–5
  5. Halliday K, Maskell G. Radiology: GIRFT Programme National Specialty Report. Nov 2020. https://www.gettingitrightfirsttime.co.uk/wp-content/uploads/2020/11/GIRFT-radiology-report.pdf
  6. Rubin C, McCafferty I, Bell J. Provision of Interventional Radiology Services, 2nd

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