In the early days of interventional radiology, it was mainly used as a way to make cardiovascular procedures less invasive. However, minimally invasive procedures have grown in popularity with both providers and patients and technological advances have allowed interventional physicians to break into previously inaccessible subspecialties.
This rapid growth meant concrete guidelines were few and far between, according to the Society of Interventional Radiology, who published staffing protocols in the May 2016 issue of the Journal of Vascular and Interventional Radiology. They followed up this year with an article published in the same journal, titled “Resource and Environment Recommended Standards for IR,” outlining the basic space and equipment requirements for an effective interventional practice.
The interventional radiology (IR) surgical suite should be at least 650 square feet, with three to four rooms dedicated for IR patient surgical preparation and recovery, according to lead author and Ontario radiologist Mark O. Baerlocher, MD, et al.
“Patient flow in the IR periprocedural areas should be under the control of the IR team and not dependent on recovery room availability related to other services, unless the area is specifically designed for this purpose and procedures, policies, and processes are established and defined to ensure adequate staffing and space needs for safe and appropriate patient care,” they wrote. “There should be a process in place by which to monitor and optimize patient and procedure/room turnover; workflow in the IR suite should not be delayed by inadequate resources for patient care and recovery after the procedure.”
In addition, contingency plans for unexpected surges in IR caseload are a must, including provisions for extra space within the hospital and transfer agreements with other hospitals.
“For example, the contact information for both the referring and the accepting physician and the requisite medical documents and/or information to be transferred should be clear to facilitate efficient communication, as should the protocol for after the intervention and repatriation where relevant,” wrote Baerlocher et al.
Aside from meeting the usual federal and state regulations on electrical, temperature, ventilation and lighting control, interventional suites need immediate access to resuscitation equipment.
Interventional radiologists are taking an increasingly large role in emergency management, according to a study published in Seminars in Interventional Radiology, finding treatment niches such as patients with suspected trauma to abdominal organs. While all patients can unexpectedly deteriorate during an interventional procedure, these emergency patients underscore the need for accessible resuscitation equipment, according to Baerlocher and colleagues.
Power injectors for contrast and equipment to convert a non-arterial case to an arterial case are other must-haves, the authors wrote.
“Power injectors have been demonstrated to lead to significantly superior image quality, reduced contrast agent use, and lower patient and worker radiation exposure,” wrote Baerlocher and colleagues. “Reduced contrast agent use in particular reduces the risk of patients developing contrast-induced nephropathy and results in cost savings. Power injectors can also be used for planned vascular work or for converting nonvascular cases into vascular cases should an adverse event occur.”
In addition, IR suites should have the full spread for radiation monitoring and management, including lead aprons, lead glasses, dose recording software, and more. A minimum of 50 square feet should be allotted for storing supplies of all types, according to Baerlocher et al.
“Given that IR is a growing field with innovation leading to new minimally invasive, image-guided procedures being offered, planning of an IR department should include a view to the future addition of procedure types and volumes,” they wrote. “It is likely that more procedures will move from a traditional operating room setting to a minimally invasive, image-guided IR procedural environment.”