By Brandy Easa, MSN, RN, CRN
Interventional radiology is a rapidly evolving field with increasingly more complex and technical life-saving procedures that previously could only be performed in the operating room. These procedures require much time and resource which can strain an already full schedule. The challenges of getting procedures on the IR schedule in a timely fashion compete with the overall volume, presenting a unique barrier to reducing lead times.
The decision was made to trial a Saturday clinic with a goal to reduce lead times. The thyroid fine needle aspiration (FNA) for biopsy was determined to be the focus procedure for this trial. Thyroid FNA is a low-risk, non-sedated option that could turn over a number of cases in a short time.
Planning for this clinic required conversations with various stakeholders to determine the availability of resources.
- The interventional radiologist was supportive and agreed to come in on a Saturday.
- Radiology RNs, specimen collector and sonographer were also recruited with incentive pay.
- Pathology determined the method of specimen preservation appropriate that would last over the weekend until specimens could be processed on Monday.
- Pathology also coordinated with the system lab to ensure everyone knew about the influx of specimens.
- Patient Access Services confirmed a registrar available to register patients and a workflow was developed with PAS to alert the team when the patients were ready to be taken for the procedure.
- Patients were scheduled every half hour to allow for registration time and no patients with more than two sites were scheduled during this clinic.
At this point, finding an appropriate space was our next step. The recovery unit attached to the cath lab was secured, an ideal area with nine bays in a contained area and a centralized nursing station. A cart was stocked with all needed procedure supplies. A checklist was made for the team from which to base their process on the day of the clinic.
On the clinic day, the following workflow was followed:
The team arrived 30 minutes prior to the start of the clinic to set up the space. On arrival the patients were registered and the registrar called the team. The RN retrieved the patient, brought them to a bay, did an initial set of vital signs and labeled the consent form. The specimen collector prepared the labels for the specimens. The ultrasound technologist did the preliminary scout scan. The physician arrived, viewed the images and performed the consent. The procedure began with a time out conducted by the RN. As the procedure ended the RN did discharge teaching and recovered the patient. Once parameters were met the patient was walked out by their RN. The room was turned over by the RN or the specimen collector depending on who was available.
As this procedure was occurring, the second RN was ready to accept the next patient and take them through the same process. The RNs alternated taking the patients and kept the schedule moving. Our thyroid clinic proved beneficial:
- The lead time for thyroid biopsies was cut by half.
- Time was open on the schedule during the week for more complex cases that needed more resources to perform.
- Patient satisfaction was clear – uniformly patients were pleased to reduce their wait for an appointment and had the added benefit of not needing to take off work.
While the financial return on thyroid FNA is fairly low, the difference is made up in the open slots created in the schedule for more complex and higher revenue cases.
RAD Idea submission
