Authors: (including presenting author): :
Chow SY, Tai WS, So SW, Fenn D, Wong CL, Lee KH, Ng J, Cho HY
Affiliation: :
Department of Diagnostic and Interventional Radiology Kwong Wah Hospital
Introduction: :
With advancements in technology, role of minimally invasive procedures performed through Interventional Radiology (IR) has expanded in recent decades. The increasing demand for IR procedures and the trend towards ambulatory care for patients undergoing such procedures has prompted a reevaluation and reform of our service delivery model to meet demands and needs of stakeholders in hospitals and the community.
Objectives: :
Develop a set of strategies to address bed occupancy congestion and long waiting times in IR procedures by improving workflow efficiency, reducing hospitalization duration, optimizing pre-procedure preparation, and maximizing utilization of appointment slots through enhanced patient knowledge and cooperation.
Methodology: :
1. Implement an ambulatory-based workflow for Ultrasound (US) Guided Fine Needle Aspiration (FNA) Thyroid: - Designated procedures and post-procedure observation rooms for day procedures. - Radiology nurse ensuring patient readiness and providing post-procedure care. - Patient discharge conducted by radiologists. 2. Expand the service scope in the Interventional Radiology (IR) Clinic: - Increased attendance quotas in each regular clinic session. - Increased case mix for pre-procedural consultations. - Inclusion of follow-up for post-ablation cases. 3. Implement Cross-Specialty Consultation for Urgent/Early requests of IR Procedures during office hours (Monday to Friday, excluding public holidays): - A brand new model of IR In-patient consultations with bedside ultrasonography in ward, with consent preparation, appointment scheduling and procedure preparation communicated to parent team by Radiology outreach team. 4. Strengthen competence of Nursing Team in specialty knowledge and expand skills of PCA II team in providing pre- and post-patient care when undergoing simple IR procedures. 5. Empower patients through pre-procedural education for ablation procedures conducted by radiology nurses.
Result & Outcome: :
Results: 1. US FNA with Outpatient Attendance: - Decreased hospital bed occupancy. - Reduced workload in clinical units. - Increased service capacity in each session. 2. IR Clinic Service Expansion: - Empowered patients with knowledge regarding high-risk IR procedures. - Reduced workload in clinical units for procedure explanation and preparation. - Increased clinical experiences for radiologist trainees and radiology nurses. 3. Fast-track In-patient IR Consultation: - All indicated Urgent/Early IR requests were accommodated within 24 hours during weekdays (excluding public holidays), with bedside ultrasonography performed and appointments scheduled accordingly. - Increased efficiency in patient care pathway. - Reduced workload and time consumed by house officers, eliminating need to bring bulky patient files for booking in radiology department and allowing more time for other clinical work. - Enhanced clinical exposure for radiologist trainees and radiology nurses. - Reduced workloads for duty radiologists in handling ad-hoc requests. 4. Strengthened Competence: - Enhanced efficiency and safety for patients undergoing IR procedures. - Enhanced nursing team competency with specialty nurse training with PRCC and, facilitated PCA team in skills enhancement. 5. Patient Empowerment: - Patients exhibited positive responses after education by radiology nurses. - Increased levels of cooperation during ablation procedures, especially in elderly patients. - Enhanced safety and minimized risks for both patients and the operating team. Conclusions: The implemented strategies have demonstrated positive effects in terms of facilitating fast access to radiology services and meeting the growing demands and expectations of end users. The introduction of new workflows and environments through new service delivery model in KWH has alleviated limitations. Further planning for development of ambulatory care aimed at reducing high admission rates and decreasing waiting times in Interventional Radiology procedures remains a priority in radiology.
