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Providing access to interventional radiology services, seven days a week Improving Quality NHS British Society of Interventional Radiology
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Interventional radiology 7 days a week

Aug 23, 2014

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Providing access to interventional
radiology services, seven days a week


Interventional radiology procedures are low volume and have a number of complex challenges. The service configuration at each Trust differs and is dependent on the number and the skill mix of interventional radiology consultants in the Trust. It is a service that supports a wide range of clinical pathways.

Based on the work of the NHS England Seven Day Services Forum and NHS Improving Quality’s Seven Day Services Improvement Programme (SDSIP), the focus for the 2013/14 interventional radiology programme has been to develop networks to deliver seven day access for nephrostomy, embolisation for haemorrhage and embolisation for post-partum haemorrhage.

Nephrostomy is a core interventional radiology service required for patients with a potential to deteriorate and require urgent intervention. Embolisation for haemorrhage usually, but not exclusively, is performed as an emergency/urgent intervention.Embolisation for post-partum haemorrhage may involve predelivery planning and be performed as an emergency/urgent intervention.
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Page 1: Interventional radiology 7 days a week

Providing access to interventionalradiology services, seven days a week

Improving QualityNHS

British Society of Interventional Radiology

Page 2: Interventional radiology 7 days a week

ContentsForeword

Executive summary

Introduction

Economic benefits

The Sheffield Experience

Focus on procedures

3

4

5

8

9

10

12

19

21

22

24

25

26

National picture - whereare we now and where arewe going?

Emerging themes

Appendix A

Appendix B

References

Contacts

Glossary

Page 3: Interventional radiology 7 days a week

More than ever before, the NHS is attempting to focus care around theneeds of our patients, ensuring we offer them a safe environment inwhich to receive care and treatment, irrespective of the point in thepatient’s journey or indeed the day that they require that care.

To this end we are looking at whole pathways of care across the system that may crossboth organisational boundaries, or between different types of provision across the healthand social care system.

Providing access to Interventional Radiology services, seven days a week pulls together theresponses from three annual national Interventional Radiology (IR) surveys and intelligencegathering from across England. NHS Improving Quality have reviewed IR services acrossthe country and confirmed that more improvement work is necessary to ensure equitableaccess to IR services for patients seven days a week (1).

Cutting across several clinical specialties this report explores some of the issues andchallenges in delivering high quality IR services both nationally and locally and seeks toshare good practice and innovations around novel delivery models. It provides practicalguidance for assessing your own service as well as service improvement ideas that somenetworks have adopted, which could be adapted to improve services further.The core purpose of this publication is to highlight key features that constitute a safe andeffective IR service. I recommend that you use it to review the IR services you provide orcommission to ensure delivery of an effective and sustainable IR service.

Professor Erika Denton FRCP, FRCRNational Clinical Director for Diagnostics, NHS England

Professor Duncan Ettles MB ChB (Hons), MD, FRCP (Ed), FRCRPresident, British Society of Interventional Radiology

Foreword by Professor Erika Dentonand Professor Duncan Ettles

Foreword 3

Page 4: Interventional radiology 7 days a week

Interventional radiologyprocedures are low volume andhave a number of complexchallenges. The serviceconfiguration at each Trust differsand is dependent on the numberand the skill mix of interventionalradiology consultants in the Trust.It is a service that supports a widerange of clinical pathways.

Based on the work of the NHSEngland Seven Day ServicesForum and NHS ImprovingQuality’s Seven Day ServicesImprovement Programme (SDSIP),the focus for the 2013/14interventional radiologyprogramme has been to developnetworks to deliver seven dayaccess for nephrostomy,embolisation for haemorrhageand embolisation for post-partumhaemorrhage. Nephrostomy is acore interventional radiologyservice required for patients witha potential to deteriorate andrequire urgent intervention.Embolisation for haemorrhageusually, but not exclusively, isperformed as an emergency/urgent intervention.Embolisation for post-partumhaemorrhage may involve pre-delivery planning and beperformed as an emergency/urgent intervention.

Executive summary

4 Executive summary

High quality interventional radiology services areessential for safe and effective patient care

There is variation in the provision of interventionalradiology throughout England, particularly forpotentially lifesaving emergency and out of hoursprocedures

Networked delivery models will be essential to improveaccess to interventional radiology. There are challengesin developing effective operational delivery networks,primarily due to the shortfall in the recruitment ofconsultant interventional radiologists

A good well resourced interventional radiology servicecan contribute to significant savings (both financial andnon-financial), as well as improve patient outcomes alongcare pathways in both planned and emergency care. (Seeexample of interventional radiology impact forperipheral vascular disease in diabetic patients)

Understand your current service provision to support yourimprovement efforts (see Appendix B for suggested baselining templates)

KEY MESSAGES

Page 5: Interventional radiology 7 days a week

Introduction 5

Interventional radiology is acomparatively new sub-specialtyof radiology, sometimes knownas ‘surgical radiology’. It is oftenmistakenly viewed as a purelydiagnostic radiology servicewhere patients and the clinicalcommunity are commonlyunaware of the benefits ofinterventional radiologytreatments. The proceduresrequire the use of imagingtechniques to guideinterventional instruments intoblood vessels and organs, todiagnose and treat a wide rangeof clinical conditions. Theseinnovative techniques can oftenprovide patients with a bettertreatment option to conservativemanagement or surgery, as thetechniques are minimally invasiveand reduce the physical traumato the patient and the infectionrisk, therefore, enabling thepatient to have an easier andfaster recovery often as a daycase. Interventional radiologyinterventions can also be highlybeneficial in urgent andemergency situations.

Diagnostic radiologists sometimesperform some of the simpleimage guided procedures such asnephrostomy and abscessdrainage, but interventional

Introduction

radiologists are sub-specialistswho perform the wider range ofinterventional procedures.Interventional radiologists arealso often required to work inclinical sub-specialties, whichmean that skill mix and numbersof interventional radiologistsavailable in each specialty can belimited as there is a nationalshortage of interventionalradiologists nationally, and thiscan hinder the level of service anacute hospital can provide.

In December 2013, NHS Englandpublished Everyone Counts:Planning for patients 2014/15 to2018/19 (2). It included a numberof offers to NHS commissioners,to give them the insights andevidence they need to producebetter local health outcomes. Itstated, that the NHS will movetowards routine services beingavailable seven days a week. It issupported by; Towards BestPractice in InterventionalRadiology (NHS Improvement,2012)(3) , which sets out casestudies using interventionalradiology service delivery modelsthat provide benefits for patientsand staff.

To support seven day woking, the National Medical Director,

Professor Sir Bruce Keogh,established the NHS Services,Seven Days a Week Forum, toconsider the consequences of thenon-availability of clinical servicesacross the seven day week, andprovide proposals forimprovements to anyshortcomings. The Forum hasestablished thematic workstreamswhich include clinical standardsthat specifically relate todiagnostics and intervention/keyservices.

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6 Introduction

The supporting information forStandard 5 Diagnostics states,‘where a service is not availableon site (e.g. InterventionalRadiology / Endoscopy orMagnetic Resonance Imaging(MRI) clear patient pathwaysmust be in place betweenproviders.’

Standard 6 Intervention/KeyServices states, ‘Hospitalinpatients must have timely 24hour access, seven days a week,to consultant-directedinterventions that meet therelevant specialty guidelines,either on-site or through formallyagreed networked arrangementswith clear protocols, such as:

• Critical care • Interventional radiology • Interventional endoscopy • Emergency general surgery.

To support this, NHS ImprovingQuality’s 2013/14 InterventionalRadiology ImprovementProgramme has focused onfacilitating the development ofinterventional radiology networksand the completion of the thirdannual national interventionalradiology survey.

This has been with the support ofthe British Society of InterventionalRadiology (BSIR) and the BSIRSafety and Quality Group. TheBSIR has representation from theMedicines and Healthcare productsRegulatory Agency (MHRA) andthe Society of InterventionalRadiology Nurses andRadiographers. Whilst promotingbest practice, the BSIR has alsoidentified 15 exemplar sites acrossthe UK based on an agreed set ofquality standards (4).

Diagnostic standards

Page 7: Interventional radiology 7 days a week

Introduction 7

NICE Guideline (CG119): Management of Diabetic Foot

NICE Guideline (CG141): Acute upper gastrointestinal bleeding overview

NICE Guideline (CG147): Lower limb peripheral arterial disease

NICE Guideline (IPG127): Endovascular stent-graft placement in thoracic aorticaneurysms and dissections

DH Clinical Policy: Cardiovascular Disease Outcomes Strategy

The Role of Emergency and Elective Interventional Radiology in PostpartumHaemorrhage (Good Practice No. 6), Royal College of Obstetricians andGynaecologists (2007)

Investigation into 10 maternal deaths at, or following delivery at, Northwick ParkHospital, North West London Hospitals NHS Trust, between April 2002 and April 2005,Healthcare Commission (2006)

Interventional Radiology: Improving Outcomes and Quality for Patients (Departmentof Health, 2009) and Interventional Radiology: a guide to service delivery(Department of Health, 2010) Annex C Adverse events

The NHS Atlas of Variation in Diagnostic Services (NHS and Public Health England,2013) www.rightcare.nhs.uk/index.php/atlas/diagnostics-the-nhs-atlas-of-variation-in-diagnostics-services

CASE FOR CHANGE

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8 The Sheffield Experience

By using early re-vascularisation andinterventional radiology proceduresinstead of conservative management,Sheffield experienced a 70% reductionin the amputation rate. Referral

VS or IR ifrest pain

Diabetes ward

Assessment

Imaging MDT

MDT

Day case

Follow up

Wounddebridement

Follow up

Assessment

Patient pathway

VS - Vascular SurgeryIR - Interventional RadiologyMDT - Multidisciplinary team

The Sheffield Experience

Page 9: Interventional radiology 7 days a week

Economic benefits 9

The clinical and economical value ofearly re-vascularisation for peripheralvascular disease in diabetic patients.

Burden of disease in the UK(diabetes 5% prevalence)

Diabetic population

Diabetics with peripheral vascular disease

Amputations - diabetic patients

Comparison of lower limb amputation rate indiabetic population

UK

Germany

Italy

Comparison of procedures and hospital costs

Angioplasty (IR)

Stenting (IR)

By-pass (surgery)

Amputation (surgery)

Population size

3,380,684

676,131

8,684

Percentage rate

0.26%

0.21% (UK 38% higher)

0.16% (UK 17% higher)

£1898

£2393

£6460

£12,075

Economic benefits

Page 10: Interventional radiology 7 days a week

10 Focus on procedures

Procedure

1) Nephrostomy

2) Embolisation for haemorrhage

3) Embolisation for post-partum haemorrhage

Descriptor

An artificial opening created between thekidney and the skin used to drain urine fromthe kidney to a bag outside the body

A minimally invasive procedure which involvesthe selective occlusion of blood vessels toprevent haemorrhage

A minimally invasive procedure which involvesthe selective occlusion of blood vessels toprevent haemorrhage in childbirth

Focus on procedures

Possible patient pathways - where interventional radiology procedures could be utilised

Acute renalSepsis Chronic renal failure

OBSTRUCTED KIDNEY

Retrograde stenting

(urologist)Nephrostomy

(IR)Retrograde

stenting (urologist)

E!ective group

Nephrostomy(IR)

SurgeryD&C balloonMedical treatment

Embolisation(IR)

POSTPARTUM HAEMORRHAGE

IR - Interventional Radiology

Page 11: Interventional radiology 7 days a week

Focus on procedures 11

IR - Interventional Radiology

Endoscopy(negative)Endoscopy (positive)

Therapeutic endoscopydependant on skills

of operator

Embolisation (IR)

CT angiogram

Repeat endoscopy

UPPER GASTROINTESTINAL HAEMORRHAGE

Failure at thisstage may trigger

referral to IR

Patientunstable

Patient stable/controlled resuscitation

Colonoscopy

Bleeding source identi!ed

LOWER GASTROINTESTINAL HAEMORRHAGE

Bleeding source not identi!ed

Resuscitation

Urgent Colonoscopy +/- and OGD

LaparotomyConservative

treatmentSurgery IR CT scan

Negative Bleeding sourceidenti!ed

Angiography ifbleeding continues

IR

Surgery (if IR fails)

Surgery (if IR fails)

Page 12: Interventional radiology 7 days a week

12 National picture - where are we now and where are we going?

A third annual interventionalradiology survey of all hospitalsin England, to demonstrate thelevel of access to 24/7interventional radiology serviceswas conducted in Autumn2013. The survey focused onthe 3 procedures (nephrostomy,embolisation for haemorrhageand post-partum haemorrhage),plus endovascular intervention(covering other coreinterventional radiologyprocedures). The selfassessment results confirmedimprovements in the 24 hour

service provision for 2 of the 3key procedures, nephrostomyand embolisation forhaemorrhage, as well as forendovascular intervention(covering other coreinterventional radiologyprocedures), and provided abase line for embolisation forpost-partum haemorrhage.Further improvements areexpected throughout 2014having gained an insight intoTrusts’ annual interventionalradiology plans.

National picture - where are we nowand where are we going?

Interventional radiology survey 2013

Page 13: Interventional radiology 7 days a week

National picture - where are we now and where are we going? 13

National RAG status for nephrostomy

Nephrostomy in hours service provision 2012

KEY

GREEN: Core serviceprovision on site or formalnational pathways to anagreed recipient trust

RED: No core serviceprovision

WHITE: No data

Data as at 10 January 2014Number of responses = 151 out of 151100% response rate over 2011/2012

KEY

GREEN: Core serviceprovision on site or formalnational pathways to anagreed recipient trust

AMBER: Plan in place toprovide service/formalpathway within the next 12months

RED: No core serviceprovision and no plans toprovide in the next 12months

WHITE: No data

Data as at 10 January 2014Number of responses = 122 out of 151100% response rate over 2011/2012

Nephrostomy in hours service provision 2013

Nephrostomy out of hours service provision 2012

KEY

GREEN: Core serviceprovision on site or formalnational pathways to anagreed recipient trust

RED: No core serviceprovision

WHITE: No data

Data as at 10 January 2014Number of responses = 151 out of 151100% response rate over 2011/2012

KEY

GREEN: Core serviceprovision on site or formalnational pathways to anagreed recipient trust

AMBER: Plan in place toprovide service/formalpathway within the next 12months

RED: No core serviceprovision and no plans toprovide in the next 12months

WHITE: No data

Data as at 10 January 2014Number of responses = 122 out of 151100% response rate over 2011/2012

Nephrostomy out of hours service provision 2013

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14 National picture - where are we now and where are we going?

National RAG status for embolisation for haemorrhage

Embolisation for haemorrhage: general in hours service provision 2012

KEY

GREEN: Core serviceprovision on site or formalnational pathways to anagreed recipient trust

RED: No core serviceprovision

WHITE: No data

Data as at 10 January 2014Number of responses = 151 out of 151100% response rate over 2011/2012

KEY

GREEN: Core serviceprovision on site or formalnational pathways to anagreed recipient trust

AMBER: Plan in place toprovide service/formalpathway within the next 12months

RED: No core serviceprovision and no plans toprovide in the next 12months

WHITE: No data

Data as at 10 January 2014Number of responses = 122 out of 151100% response rate over 2011/2012

Embolisation for haemorrhage: general in hours service provision 2013

Embolisation for haemorrhage: general out of hours service provision 2012

KEY

GREEN: Core serviceprovision on site or formalnational pathways to anagreed recipient trust

RED: No core serviceprovision

WHITE: No data

Data as at 10 January 2014Number of responses = 151 out of 151100% response rate over 2011/2012

KEY

GREEN: Core serviceprovision on site or formalnational pathways to anagreed recipient trust

AMBER: Plan in place toprovide service/formalpathway within the next 12months

RED: No core serviceprovision and no plans toprovide in the next 12months

WHITE: No data

Data as at 10 January 2014Number of responses = 122 out of 151100% response rate over 2011/2012

Embolisation for haemorrhage: general out of hours service provision 2013

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National picture - where are we now and where are we going? 15

National RAG status for endovascular intervention

Endovascular intervention in hours service provision 2012

KEY

GREEN: Core serviceprovision on site or formalnational pathways to anagreed recipient trust

RED: No core serviceprovision

WHITE: No data

Data as at 10 January 2014Number of responses = 151 out of 151100% response rate over 2011/2012

KEY

GREEN: Core serviceprovision on site or formalnational pathways to anagreed recipient trust

AMBER: Plan in place toprovide service/formalpathway within the next 12months

RED: No core serviceprovision and no plans toprovide in the next 12months

WHITE: No data

Data as at 10 January 2014Number of responses = 122 out of 151100% response rate over 2011/2012

Endovascular intervention in hours service provision 2013

Endovascular intervention out of hours service provision 2012

KEY

GREEN: Core serviceprovision on site or formalnational pathways to anagreed recipient trust

RED: No core serviceprovision

WHITE: No data

Data as at 10 January 2014Number of responses = 151 out of 151100% response rate over 2011/2012

KEY

GREEN: Core serviceprovision on site or formalnational pathways to anagreed recipient trust

AMBER: Plan in place toprovide service/formalpathway within the next 12months

RED: No core serviceprovision and no plans toprovide in the next 12months

WHITE: No data

Data as at 10 January 2014Number of responses = 122 out of 151100% response rate over 2011/2012

Endovascular intervention out of hours service provision 2013

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16 National picture - where are we now and where are we going?

National RAG status for postpartum haemorrhage

Embolisation for postpartum haemorrhagein hours service provision 2013

KEY

GREEN: Core serviceprovision on site or formalnational pathways to anagreed recipient trust

AMBER: Plan in place toprovide service/formalpathway within the next 12months

RED: No core serviceprovision and no plans toprovide in the next 12months

WHITE: No data

Data as at 10 January 2014Number of responses = 122 out of 151100% response rate over 2011/2012

KEY

GREEN: Core serviceprovision on site or formalnational pathways to anagreed recipient trust

AMBER: Plan in place toprovide service/formalpathway within the next 12months

RED: No core serviceprovision and no plans toprovide in the next 12months

WHITE: No data

Data as at 10 January 2014Number of responses = 122 out of 151100% response rate over 2011/2012

Embolisation for postpartum haemorrhage out of hours service provision 2013

The national survey askedproviders what they consideredto be the rate limiting step innot providing a comprehensiveinterventional radiology service.

Rate limiting factors for not deliveringservice at present time (England)

New interventionalradiology facility5%

Interventionalradiologistappointments22%

Interventional nurse appointments18%

Interventionalnurse rota19%

Interventionalradiographer rota17%

Network approachto service delivery19%

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National picture - where are we now and where are we going? 17

Delivering and sustaining 24 hour interventionalradiology services - percentage units providing24 hour service cover for key procedures

The survey also askedinterventional radiology servicesto comment on whether theywere planning to deliver servicechanges within the next 12months. Encouragingly it wasthe intention of many servicesto deliver more comprehensiveservice delivery models.However, considering the ratelimiting steps as described byproviders, it would require afurther survey to determinewhether they are successful intheir ambitions.

90%

80%

70%

60%

50%

40%

30%2012 2013 Next 12 months

Nephrostomy

Embolism forhaemorrhage - general

Endovascularintervention

Embolisation forpostpartumhaemorrhage

The development of networkedapproaches and solutions withfive regions in England hasfocused on the comprehensivebaselining of services. Templatesto support such work can befound in Appendix B, enablingproviders to progress withdefining and formalisingpathways of care to ensurepatients have access tointerventional radiology services,seven days a week. Strongcollaborative working betweenTrusts and good practiceexamples were particularlyevident within the East Midlandsnetwork, where work isunderway to address many ofthe challenges faced byinterventional radiology serviceproviders, such as therecruitment and retention ofconsultant interventionalradiology radiologists.

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18 National picture - where are we now and where are we going?

Networking

Facilities andprocesses

Funding

Staffing andteam working

Example 1

Joint appointments forinterventional radiologyvascular consultant(s) and/orvascular surgeon(s), tosupport 1 in 6 rota standardsfor vascular services

4 dedicated beds in a daycase area located in thedepartment allowing directpatient observation andcorrect income allocation

Focus on cost benefits ofinterventional radiologyprocedures, with good inter-department support fromdata managers in renal,vascular and neurologicaldisciplines, allowing forpatient and consultant levelcosting

Well developed competencyassessment framework forconsultants, radiographersand nurses to support roledevelopment and skill mixutilisation

Example 2

Formal pathways in placefor referral of specialistand generic interventionalradiology work to othercentre

Pre assessment donejointly by interventionalradiology and vascularstaff utilising a dedicatedconsulting room in thedepartment

Example 3

Links with local commissioners on increase in demand forendovascular aneurysm repair(EVAR) and fenestrated EVAR(FEVAR) and new ClinicalCommissioning Policy forendovascular stent grafts inabdominal aortic aneurysm

Standardised interventionalradiology kit at two sites withinthe same Trust to support standardworking and to facilitate cross siteworking

Collaborative working and best practice examples from East Midlands Network

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Emerging themes 19

Based on the work throughout2013/14, the following emergingthemes were identified fordelivering seven dayinterventional radiology services,to support the NHS Services,Seven Days a Week Forum:

1. Patient safety/Adverseevents – The interventionalradiology adverse events (March2013 - see Case for Change andAppendix A) are serviceaspirations and althoughendorsed by the BSIR they are notincluded in the 25 Never Events,which are reportable incidents forTrusts. There appears to bevariation in the knowledge andunderstanding of theinterventional radiology adverseevents throughout England.

2. Workforce – The Centre forWorkforce Intelligence report(December 2012) states that thenational gap in interventionalradiology consultant posts is inexcess of 220 in England. Presenttraining numbers will not meetthis deficit. Interventionalradiology training programmesare less formalised than otherspecialities, with recruitmentfrom a pool of radiology trainees.European interventional radiologyrecruitment is underway buttraining in Europe is very different

Emerging themes

to the English/UK system andcandidates require intensivetraining and supervision. This‘sellers’ market means that theinterventional radiologyradiologist workforce is verymobile which creates serviceinstability, particularly in ‘hard torecruit to’ locations. Some Trustshave secured joint interventionalradiology consultantappointments or are exploringthe potential for jointappointments as a solution to thenational recruitment issue. Inaddition, the skills of individualinterventional radiologyconsultants in Trusts oftendetermine the services delivered,rather than a service based onpopulation need.

3. Commissioning and finance– There is variation inunderstanding that interventionalradiology can deliver a costeffective, safe and alternativeservice to more invasiveprocedures such as surgery. Tarifffor interventional radiologyprocedures is not unbundled andcoding is often an issue forinterventional radiologydepartments. Some interventionalradiology services arecommissioned via nationalspecialist commissioning.

4. Networks – Networking willbe essential to improve access tointerventional radiology. Thereare challenges in developingeffective operational deliverynetworks, primarily due to theshortfall in the recruitment ofconsultant interventionalradiologists.

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20 Recommendations

The following recommendationsneed to be considered againstthe background of the NHSEngland, Seven Days a WeekForum.

Recommendations

Improving interventional radiology services should bepart of a whole pathway approach, including patientsand carers, referring clinicians (e.g. obstetricians for post-partum haemorrhage) and other key stakeholders

Ensure there is wider engagement between StrategicClinical Networks and the commissioning community andinterventional radiology service providers, to furtherdevelop appropriate network solutions to delivering safeinterventional radiology services, seven days a week

Ensure that the clinical standards relating tointerventional radiology within the NHS Services, SevenDays a Week Forum Findings are implemented

Consider commissioning a quality and cost benefitsanalysis of interventional radiology procedures versusconservative management or treatment

RECOMMENDATIONS

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Appendix A 21

The Department of Health recently published two important documents which highlighted the need forpatients to have improved access to interventional radiology (IR) servicesi ii. The evidence base is cited in thetwo publications. The key drivers behind this work are:

• improvement in patient outcomes• reduction in harm to patients who cannot access the appropriate procedure in a timely manner.

The following are scenarios which should no longer occur. Organisations should ensure that processes are inplace to protect patients from harm in these situations and should report and investigate all such events.

Failure to be able to provide these services should be appropriately identified on Trust’s risk registers. Such IRprocedures need to be carried out with appropriate suppoort from multidisciplinary radiographic/nursingsupport so that timelines for these interventions can be met:

• High risk pregnancies should be delivered in hospitals with IR services who should be involved in the pre delivery planning.

• No patient should undergo laparotomy for lower gastro intestinal (GI) bleeding from any cause where embolisation may be appropriate without a referral to interventional radiology.

• No patient should undergo surgery for non-variceal upper GI bleeding without first undergoing endoscopic treatment, and if this fails or is inappropriate, interventional radiology.

• No patient with sepsis secondary to obstructed kidneys should wait longer than three hours for a drainage procedure such as nephrostomy.

• No severely injured patient should die of haemorrhage from pelvic trauma because of a lack of early imagingand referral for interventional radiology.

• No patient with a traumatic aortic dessection should have open surgery without a referral to interventional radiology for consideration of endovascular repair.

• No patient should have open surgical repair of a GI variceal haemorrhage which is refractory to all other treatments without a referral to interventional radiology for transjugular intrahepatic portosystemic shunting (TIPS).

• `no patient with symptomatic fibroids should undergo hysterectomy without being informed about all possible options including Uterine Artery Embolisation.

Adverse events avoided by the use ofinterventional radiology

Appendix A:

BSIR/NHS Improving Quality Adverse Events

i Interventional Radiology: Improving Outcomes and Quality for Patients (2009) Gatway Reference: 12788www.dh.gov.uk/en/Publicationsandstatistics/Publications/PublicationsPolicyAndGuidance/DH_109130

ii Interventional Radiology: A guide to service delivery (2010) Gateway Reference 15003www.bsir.org/Images/_Members/_administrator/File/ir_roadmap_dh_121906.pdf

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22 Appendix B

Appendix B:

NHS Improving Quality base lining templates

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Appendix B 23

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24 References

1. NHS England (December 2013), NHS Services, Seven Days a Week Forum – Summary of Initial Findings

2. NHS England (2013), Everyone Counts: Planning for patients 2014/15 to 2018/19

3. NHS Improvement (2012), Towards Best Practice in Interventional Radiology

4. British Society of Interventional Radiology, BSIR Quality Initiative www.bsir-qi.org/apply

References

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Contacts 25

To find out more about InterventionalRadiology at NHS Improving Quality please contact the following:

Fiona Thow, Programme Director,Interventional Radiology, NHS Improving QualityEmail: [email protected]

Peter Gray, National Improvement Lead,NHS Improving QualityEmail: [email protected]

Amy Hodgkinson, National ImprovementLead, NHS Improving QualityEmail: [email protected]

Carol Marley, National ImprovementLead, NHS Improving QualityEmail: [email protected]

Carole Smee, National Improvement Lead,NHS Improving QualityEmail: [email protected]

Ian Snelling, Senior Analyst, NHS Improving QualityEmail: [email protected]

Contacts

Page 26: Interventional radiology 7 days a week

26 Glossary

Angioplasty - Technique to widen narrowed or obstructedarteries

Angiography - Imaging technique used to visualize theinside of blood vessels and organs of the body

Core Interventional Radiology Service - A set ofprocedures defined for the purpose of the national survey.These procedures should be able to be provided by allInterventional Radiology Services and include Embolization;Nephrostomy and endovascular intervention

CT - Computed Tomography - Technology that usescomputer-processed X-rays to make it possible to see threedimensional images of the body for diagnosis andtherapeutic interventions

D&C balloon - Also known as a ‘Bakri Balloon’ and is madeof silicone and specifically designed for the temporarytreatment of post -partum haemorrhage

Embolisation - Selective occlusion of a blood vessel

EVAR- Endovascular aneurysm repair - The repair of aruptured vessel which can be performed by open surgery orinsertion of a stent graft (fabric covered tube) into thevessel

FEVAR - Fenestrated endovascular aneurysm repair -Aneurysm repair that uses a device with fenestrations orholes that will accommodate arterial branches such as renalarteries

Hemi-colectomy - Operation to remove part of the largebowel

Interventional Endoscopy - Techniques involving a tubewith camera (endoscope) to perform minimally invasivediagnostic and treatment interventions

Interventional Radiology - A relatively new field ofmedical practice that uses imaging techniques to guideinterventional instruments into blood vessels and organs todiagnose and treat a wide range of clinical conditions

Nephrostomy - An artificial opening created between thekidney and the skin which allows urine to be diverted fromblocked kidneys

Glossary

Non-variceal upper GI bleeding-bleeding in the gastro - Intestinal tract that is not due to haemorrhageprone dilated blood vessels

Post-partum Haemorrhage - Bleeding in the pelvic area(often the uterus) following child birth

Renal dialysis access intervention - Insertion of cathetersor creation or repair of a renal fistula (a technique whichjoins an artery and a vein together to create a strong vesselto enable long term access for renal dialysis)

Ureteric stenting - A technique which involves insertion ofa stent/tube into the ureter (the tube between the kidneyand bladder which channels urine) to temporarily relieve ablockage

Specialist commissioning - Commissioning of specialistservices that are often high cost and/or low volume througha national rather than local commissioning approach

TACE (transarterial chemoembolisation) - A minimallyinvasive procedure performed by interventional radiologists to restrict a tumour's blood supply and insertchemotherapeutic agents into the arteries supplying thetumour

TEVAR - Thoracic endovascular aneurysm repair

TIPS - Transjugular intrahepatic portosystemic stentshunting is a technique which creates an artificial channelwithin the liver. It is used to treat liver cirrhosis whichfrequently leads to intestinal bleeding, life-threateningoesophageal bleeding and the build-up of fluid within theabdomen

Unbundled tariff - Identification of the price of servicessuch as radiology within the overall tariff

Uterine artery embolisation - A procedure where aninterventional radiologist uses a catheter to deliver smallparticles that block the blood supply to the uterine body.The procedure is done for the treatment of uterine fibroids

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@NHSIQwww.nhsiq.nhs.uk

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Published by: NHS Improving Quality - Gateway Ref: 00687 - Publication date: May 2014 - Review date: May 2015© NHS Improving Quality (2014). All rights reserved. Please note that this product or material must not be used for the purposes offinancial or commercial gain, including, without limitation, sale of the products or materials to any person.