Despite the fact that interventional radiology procedures are minimally invasive and offer a quicker recovery time, in the majority of interventional radiology departments, patients still need to occupy a hospital bed even for elective procedures. The solution may be radiology day units, writes Miltiadis Krokidis.
“Brave” interventional radiologists have recognised that there are specific procedures for selected patients that can be safely performed as day cases.
In the early days, these patients were admitted in a ward on the day of the procedure and discharged the same evening. This set-up was strongly supported by hospital managers considering that this is an era where the pressure for hospital beds is as high as ever before.
In such cases, patients were usually pre-assessed and consented either by interventional radiologists or their colleagues as outpatients prior to their admission. The initial “day-case” approach has significantly changed the management of such patients considering that a few years ago it was unthinkable to perform a peripheral angioplasty for a patient who would go home after a few hours. The increased clinical experience of interventional radiologists in the last decades, and the significant technical advances in the field in terms of minimally invasive access and control of bleeding has transformed this vision in to a clinical reality.
The encouraging results of the “day-case” approach offered suitable soil for putting together business cases for radiology day units. These have been developed in interventional radiology departments throughout the UK.
This evolution has offered a number of advantages regarding service effectiveness and patient management.
The main advantage of radiology day units is linked to the nursing staff. The nursing staff of such a unit is the same staff that is rotating in the interventional radiology department. Nurses that look after the patients have a very good knowledge of specialised interventional radiology procedures and therefore hand-over is significantly quicker than with ward nurses. Also, they are specifically trained to monitor interventional radiology patients and recognise post-procedural complications and act swiftly in the interest of patient safety. Another advantage is the fact that radiology day units are located within the radiology department. Therefore patients are transferred much quicker without unnecessary delays to the interventional radiology suite and the interventional radiology lists run more effectively, increasing productivity. In addition interventional radiologists can visit patients promptly if required and be in contact with the patient prior to discharge easily in addition to managing their clinical commitments. A day unit that functions for 12 hours may accommodate patients from both morning and afternoon lists.
Several types of cases may recover in the unit based on the clinical judgement of the operator. Procedures like biopsies, diagnostic angiograms, nephrostomies, ureteric stent insertions and venous procedures (venous sampling, venous embolization) should be able to be performed as day cases without any problems. More complex procedures such as angioplasties need to be evaluated individually and the complexity of the case will influence the decision made by the team.
In Cambridge University Hospitals, between May 2013 and August 2014, 273 patients with peripheral vascular disease underwent an angioplasty as a day case and recovered in the radiology day unit. The mean age of the patients was 68.9 years with a range between 46 and 93 years. The vast majority (77%) were patients with intermittent claudication, however 63 patients with critical limb ischaemia (Rutherford stage 4 to 6) were also treated as day cases. The majority of cases (67%) were disease in the femoropopliteal segment and the most common treatment was angioplasty that was performed through a 4F or a 5F sheath, however 44 patients (16%) underwent angioplasty and stenting through a 6F (24/44) or even a 7F (20/44) sheath; punctures were mainly antegrade from the common femoral artery, but in one case, the combination of an antegrade common femoral and a retrograde popliteal access was also performed. Closure devices were used where necessary and only in six cases an overnight bed was required. This data is a good example of the fact that a vast majority of the peripheral vascular procedures may be treated as day cases in a well-functioning day unit offering shorter hospitalisation time for the treatment of a very common condition that would otherwise require a number of hospital beds.
Of course, accurate patient assessment is of paramount importance prior to making a “day case” route decision. This decision is clinical and needs to be made by the operator, therefore interventional radiologists need to be committed to outpatient assessments ideally in designated clinics prior to any day case treatment. The combination of interventional radiology outpatient clinics and well-functioning radiology day units is one of the most viable routes by which minimally invasive treatment is changing healthcare management in modern hospitals, and we are delighted to be part of this transformation.‰Û¬
Miltiadis Krokidis is a consultant vascular and interventional radiologist, Cambridge University Hospitals, Cambridge, UK. He has reported no disclosures pertaining to the article