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2.
J Vasc Interv Radiol ; 30(6): 956-960, 2019 Jun.
Artigo em Inglês | MEDLINE | ID: mdl-30878359

RESUMO

Integrating interventional radiology (IR) into clinical practice faces challenges in emerging countries in Asia and Africa. Overcoming them requires innovative solutions customized to local needs. After an in-depth gap analysis of these challenges, we began an organized skill development initiative in late 2015 offering radiologists and their supporting staff fully paid scholarships for IR training. Its concept, structure, and progress are reported here. This initiative covered 8 countries, IR specialists (n = 51), senior residents (n = 24), and 15 educational events (training institute [n = 3]; participating countries [n = 12]). This initiative is intended to develop a global network of trained personnel who can support IR programs in challenging locations of emerging countries.


Assuntos
Prestação Integrada de Cuidados de Saúde , Países em Desenvolvimento , Educação de Pós-Graduação em Medicina , Radiografia Intervencionista , Radiologistas/educação , Radiologia Intervencionista/educação , Competência Clínica , Currículo , Prestação Integrada de Cuidados de Saúde/organização & administração , Educação de Pós-Graduação em Medicina/organização & administração , Humanos , Curva de Aprendizado , Radiologistas/organização & administração , Radiologia Intervencionista/organização & administração
3.
Tech Vasc Interv Radiol ; 21(4): 295-304, 2018 Dec.
Artigo em Inglês | MEDLINE | ID: mdl-30545508

RESUMO

Aviation and medicine are two complex fields involving many interdependent steps where problems can occur. When they inevitably do the outcome can be catastrophic, leading to injury or even loss of life. While both professions have made great strides to reduce error and improve safety, we would suggest medicine can still learn much from the approach aviation has developed. We will show how pilots spend a significant amount of time on planning and early recognition of impending challenges, utilize the concept of crew resource management routinely, and stay much focused during each specific mission. More importantly, they are very open and committed to discussing every event or near event to improve the system, and are supported in this by their superiors without fear of punishment or retribution. By adopting many of these principles, medicine can develop a true culture of safety such as aviation has done, leading to a remarkable improvement in their safety record.


Assuntos
Aviação , Erros Médicos/prevenção & controle , Planejamento de Assistência ao Paciente/organização & administração , Equipe de Assistência ao Paciente/organização & administração , Administração da Prática Médica/organização & administração , Garantia da Qualidade dos Cuidados de Saúde/organização & administração , Radiologia Intervencionista/organização & administração , Gestão da Segurança , Comunicação , Tomada de Decisões , Humanos , Liderança
5.
Ann Vasc Surg ; 46: 142-146, 2018 Jan.
Artigo em Inglês | MEDLINE | ID: mdl-28887248

RESUMO

BACKGROUND: In January 2015, we created a multidisciplinary Aortic Center with the collaboration of Vascular Surgery, Cardiac Surgery, Interventional Radiology, Anesthesia and Hospital Administration. We report the initial success of creating a Comprehensive Aortic Center. METHODS: All aortic procedures performed from January 1, 2015 until December 31, 2016 were entered into a prospectively collected database and compared with available data for 2014. Primary outcomes included the number of all aortic related procedures, transfer acceptance rate, transfer time, and proportion of elective/emergent referrals. RESULTS: The Aortic Center included 5 vascular surgeons, 2 cardiac surgeons, and 2 interventional radiologists. Workflow processes were implemented to streamline patient transfers as well as physician and operating room notification. Total aortic volume increased significantly from 162 to 261 patients. This reflected an overall 59% (P = 0.0167) increase in all aorta-related procedures. We had a 65% overall increase in transfer requests with 156% increase in acceptance of referrals and 136% drop in transfer denials (P < 0.0001). Emergent abdominal aortic cases accounted for 17% (n = 45) of our total aortic volume in 2015. The average transfer time from request to arrival decreased from 515 to 352 min, although this change was not statistically significant. We did see a significant increase in the use of air-transfers for aortic patients (P = 0.0041). Factorial analysis showed that time for transfer was affected only by air-transfer use, regardless of the year the patient was transferred. Transfer volume and volume of aortic related procedures remained stable in 2016. CONCLUSIONS: Designation as a comprehensive Aortic Center with implementation of strategic workflow systems and a culture of "no refusal of transfers" resulted in a significant increase in aortic volume for both emergent and elective aortic cases. Case volumes increased for all specialties involved in the center. Improvements in transfer center and emergency medical services communication demonstrated a trend toward more efficient transfer times. These increases and improvements were sustainable for 2 years after this designation.


Assuntos
Aorta/cirurgia , Doenças da Aorta/cirurgia , Procedimentos Cirúrgicos Cardíacos , Serviços Centralizados no Hospital/organização & administração , Prestação Integrada de Cuidados de Saúde/organização & administração , Radiologistas/organização & administração , Radiologia Intervencionista/organização & administração , Cirurgiões/organização & administração , Centros de Traumatologia/organização & administração , Procedimentos Cirúrgicos Vasculares/organização & administração , Procedimentos Cirúrgicos Cardíacos/classificação , Serviço Hospitalar de Cardiologia/organização & administração , Serviços Centralizados no Hospital/classificação , Comportamento Cooperativo , Bases de Dados Factuais , Prestação Integrada de Cuidados de Saúde/classificação , Procedimentos Cirúrgicos Eletivos , Emergências , Florida , Humanos , Comunicação Interdisciplinar , Equipe de Assistência ao Paciente/classificação , Equipe de Assistência ao Paciente/organização & administração , Transferência de Pacientes/organização & administração , Avaliação de Programas e Projetos de Saúde , Radiologistas/classificação , Serviço Hospitalar de Radiologia/organização & administração , Radiologia Intervencionista/classificação , Encaminhamento e Consulta/organização & administração , Estudos Retrospectivos , Cirurgiões/classificação , Terminologia como Assunto , Fatores de Tempo , Tempo para o Tratamento/organização & administração , Centros de Traumatologia/classificação , Procedimentos Cirúrgicos Vasculares/classificação , Fluxo de Trabalho , Carga de Trabalho
6.
Rofo ; 189(10): 957-966, 2017 Oct.
Artigo em Inglês | MEDLINE | ID: mdl-28834967

RESUMO

Background Radiology is an interdisciplinary field dedicated to the diagnosis and treatment of numerous diseases and is involved in the development of multimodal treatment concepts. Method Interdisciplinary case management, a broad spectrum of diagnostic imaging facilities and dedicated endovascular radiological treatment options are valuable tools that allow radiology to set up an interdisciplinary center for vascular anomalies. Results Image-based diagnosis combined with endovascular treatment options is an essential tool for the treatment of patients with highly complex vascular diseases. These vascular anomalies can affect numerous parts of the body so that a multidisciplinary treatment approach is required for optimal patient care. Conclusion This paper discusses the possibilities and challenges regarding effective and efficient patient management in connection with the formation of an interdisciplinary center for vascular anomalies with strengthening of the clinical role of radiologists. Key points · Vascular anomalies, which include vascular tumors and malformations, are complex to diagnose and treat.. · There are far more patients with vascular anomalies requiring therapy than interdisciplinary centers for vascular anomalies - there is currently a shortage of dedicated interdisciplinary centers for vascular anomalies in Germany that can provide dedicated care for affected patients.. · Radiology includes a broad spectrum of diagnostic and minimally invasive therapeutic tools which allow the formation of an interdisciplinary center for vascular anomalies for effective, efficient and comprehensive patient management.. Citation Format · Sadick M, Dally FJ, Schönberg SO et al. Strategies in Interventional Radiology: Formation of an Interdisciplinary Center of Vascular Anomalies - Chances and Challenges for Effective and Efficient Patient Management. Fortschr Röntgenstr 2017; 189: 957 - 966.


Assuntos
Equipe de Assistência ao Paciente/organização & administração , Radiografia Intervencionista/tendências , Radiologia Intervencionista/organização & administração , Doenças Vasculares/diagnóstico por imagem , Doenças Vasculares/terapia , Malformações Vasculares/diagnóstico por imagem , Malformações Vasculares/terapia , Alemanha , Humanos , Modelos Organizacionais
8.
Pediatr Radiol ; 47(3): 321-326, 2017 Mar.
Artigo em Inglês | MEDLINE | ID: mdl-27853839

RESUMO

BACKGROUND: Despite a continuing emphasis on evaluation and management clinical services in adult interventional radiology (IR) practice, the peer-reviewed literature addressing these services - and their potential economic benefits - is lacking in pediatric IR practice. OBJECTIVE: To measure the effects of expanding evaluation and management (E&M) services through the establishment of a dedicated pediatric interventional radiology outpatient clinic and inpatient E&M reporting system. MATERIALS AND METHODS: We collected and analyzed E&M current procedural terminology (CPT) codes from all patients seen in a pediatric interventional radiology outpatient clinic between November 2014 and August 2015. We also calculated the number of new patients seen in the clinic who had a subsequent procedure (procedural conversion rate). For comparison, we used historical data comprising pediatric patients seen in a general interventional radiology (IR) clinic for the 2 years immediately prior. An inpatient E&M reporting system was implemented and all inpatient E&M (and subsequent procedural) services between July 2015 and September 2015 were collected and analyzed. We estimated revenue for both outpatient and inpatient services using the Medicare Physician Fee Schedule global non-facility price as a surrogate. RESULTS: Following inception of a pediatric IR clinic, the number of new outpatients (5.5/month; +112%), procedural conversion rate (74.5%; +19%), estimated E&M revenue (+158%), and estimated procedural revenue from new outpatients (+228%) all increased. Following implementation of an inpatient clinic reporting system, there were 8.3 consults and 7.3 subsequent hospital encounters per month, with a procedural conversion rate of 88%. CONCLUSION: Growth was observed in all meaningful metrics following expansion of outpatient and inpatient pediatric IR E&M services.


Assuntos
Pediatria/organização & administração , Administração da Prática Médica/organização & administração , Radiologia Intervencionista/organização & administração , Current Procedural Terminology , Eficiência Organizacional , Honorários e Preços , Humanos , Medicare/economia , Modelos Organizacionais , Pediatria/economia , Administração da Prática Médica/economia , Padrões de Prática Médica/economia , Radiologia Intervencionista/economia , Estados Unidos , Revisão da Utilização de Recursos de Saúde
9.
J Vasc Interv Radiol ; 27(8): 1189-94, 2016 Aug.
Artigo em Inglês | MEDLINE | ID: mdl-27363297

RESUMO

PURPOSE: To quantify preprocedural patient flow in interventional radiology (IR) and to identify potential contributors to preprocedural delays. MATERIALS AND METHODS: An administrative dataset was used to compute time intervals required for various preprocedural patient-flow processes. These time intervals were compared across on-time/delayed cases and inpatient/outpatient cases by Mann-Whitney U test. Spearman ρ was used to assess any correlation of the rank of a procedure on a given day and the procedure duration to the preprocedure time. A linear-regression model of preprocedure time was used to further explore potential contributing factors. Any identified reason(s) for delay were collated. P < .05 was considered statistically significant. RESULTS: Of the total 1,091 cases, 65.8% (n = 718) were delayed. Significantly more outpatient cases started late compared with inpatient cases (81.4% vs 45.0%; P < .001, χ(2) test). The multivariate linear regression model showed outpatient status, length of delay in arrival, and longer procedure times to be significantly associated with longer preprocedure times. Late arrival of patients (65.9%), unavailability of physicians (18.4%), and unavailability of procedure room (13.0%) were the three most frequently identified reasons for delay. The delay was multifactorial in 29.6% of cases (n = 213). CONCLUSIONS: Objective measurement of preprocedural IR patient flow demonstrated considerable waste and highlighted high-yield areas of possible improvement. A data-driven approach may aid efficient delivery of IR care.


Assuntos
Agendamento de Consultas , Prestação Integrada de Cuidados de Saúde/organização & administração , Modelos Organizacionais , Radiografia Intervencionista , Serviço Hospitalar de Radiologia/organização & administração , Radiologia Intervencionista/organização & administração , Assistência Ambulatorial/organização & administração , Distribuição de Qui-Quadrado , Bases de Dados Factuais , Eficiência Organizacional , Hospitais Universitários/organização & administração , Humanos , Pacientes Internados , Modelos Lineares , Análise Multivariada , Salas Cirúrgicas/organização & administração , Pacientes Ambulatoriais , Admissão e Escalonamento de Pessoal/organização & administração , Melhoria de Qualidade/organização & administração , Indicadores de Qualidade em Assistência à Saúde/organização & administração , Estudos Retrospectivos , Fatores de Risco , Texas , Fatores de Tempo , Estudos de Tempo e Movimento
12.
J Am Coll Radiol ; 13(9): 1145-50, 2016 Sep.
Artigo em Inglês | MEDLINE | ID: mdl-27297700

RESUMO

PURPOSE: We tested the hypothesis that establishing a dedicated interventional oncology (IO) clinical service line would increase clinic visits and procedural volumes at a single quaternary care academic medical center. METHODS: Two time periods were defined: July 2012 to June 2013 (pre-IO clinic) and July 2013 to June 2014 (first year of dedicated IO service). Staff was recruited, and clinic space was provided in the institution's comprehensive cancer center. Clinic visits and procedure numbers were documented using the institution's electronic medical record and billing forms. IO procedures included were transarterial chemoembolization, Y-90 radioembolization, perfusion mapping for Y-90, portal vein embolization, and bland embolization. We compared changes in clinic visit and procedure numbers using paired t tests. Changes after IO initiation were compared to 1-year changes in the Medicare 5% Limited Data Set by cross-referencing Current Procedure Terminology and International Classification of Diseases codes in 2012 and 2013. RESULTS: Clinic visits increased from 9 to 204 (P = .003, t = 8.89, df = 3). Procedures increased from 60 to 239 (P = .018, t = 3.85, df = 4). Procedural volumes increased at least 150% for each subtype. The volumes in the 5% Limited Data Set did not change significantly over the 2-year period (443 to 385, P > .05). CONCLUSIONS: The establishment of a dedicated IO service significantly increased clinic visits and procedural volumes. National trends were unchanged, suggesting that the impact of our program was not part of a sudden increase of IO procedures.


Assuntos
Institutos de Câncer/organização & administração , Embolização Terapêutica/estatística & dados numéricos , Neoplasias/terapia , Radioterapia (Especialidade)/organização & administração , Radiografia Intervencionista/estatística & dados numéricos , Radiologia Intervencionista/organização & administração , Assistência Integral à Saúde/estatística & dados numéricos , Eficiência Organizacional , Humanos , Modelos Organizacionais , National Cancer Institute (U.S.)/organização & administração , Neoplasias/diagnóstico , Neoplasias/epidemiologia , Prevalência , Tennessee/epidemiologia , Estados Unidos , Carga de Trabalho
13.
Radiographics ; 36(3): 856-71, 2016.
Artigo em Inglês | MEDLINE | ID: mdl-27163595

RESUMO

Long wait times limit our ability to provide the right care at the right time and are commonly products of inefficient workflow. In 2013, the demand for musculoskeletal (MSK) procedures increased beyond our department's ability to provide efficient and timely service. We initiated a quality improvement (QI) project to increase efficiency and decrease patient time of stay. Our project team included three MSK radiologists, one senior resident, one technologist, one administrative assistant/scheduler, and the lead technologist. We adopted and followed the Lean Six Sigma DMAIC (define, measure, analyze, improve, and control) approach. The team used tools such as voice of the customer (VOC), along with affinity and SIPOC (supplier, input, process, output, customer) diagrams, to understand the current process, identify our customers, and develop a project charter in the define stage. During the measure stage, the team collected data, created a detailed process map, and identified wastes with the value stream mapping technique. Within the analyze phase, a fishbone diagram helped the team to identify critical root causes for long wait times. Scatter plots revealed relationships among time variables. Team brainstorming sessions generated improvement ideas, and selected ideas were piloted via plan, do, study, act (PDSA) cycles. The control phase continued to enable the team to monitor progress using box plots and scheduled reviews. Our project successfully decreased patient time of stay. The highly structured and logical Lean Six Sigma approach was easy to follow and provided a clear course of action with positive results. (©)RSNA, 2016.


Assuntos
Eficiência Organizacional , Tempo de Internação/estatística & dados numéricos , Doenças Musculoesqueléticas/diagnóstico por imagem , Doenças Musculoesqueléticas/terapia , Melhoria de Qualidade , Serviço Hospitalar de Radiologia/organização & administração , Radiologia Intervencionista/organização & administração , Listas de Espera , Fluxo de Trabalho , Humanos , Cultura Organizacional , Objetivos Organizacionais , Satisfação do Paciente
15.
Radiol Technol ; 87(3): 261-70, 2016.
Artigo em Inglês | MEDLINE | ID: mdl-26721838

RESUMO

BACKGROUND: Interventional-cardiovascular magnetic resonance (iCMR) is a promising clinical tool for adults and children who need a comprehensive hemodynamic catheterization of the heart. Magnetic resonance (MR) imaging-guided cardiac catheterization offers radiation-free examination with increased soft tissue contrast and unconstrained imaging planes for catheter guidance. The interventional MR technologist plays an important role in the care of patients undergoing such procedures. It is therefore helpful for technologists to understand the unique iCMR preprocedural preparation, procedural and imaging workflows, and management of emergencies. The authors report their team's experience from the National Institutes of Health Clinical Center and a collaborating pediatric site.


Assuntos
Cardiologia/organização & administração , Laboratórios Hospitalares/organização & administração , Imagem por Ressonância Magnética Intervencionista , National Institutes of Health (U.S.)/organização & administração , Radiologia Intervencionista/organização & administração , Descrição de Cargo , Modelos Organizacionais , Estados Unidos , Fluxo de Trabalho
16.
J Neurointerv Surg ; 8(6): 654-7, 2016 Jun.
Artigo em Inglês | MEDLINE | ID: mdl-25987588

RESUMO

The Affordable Care Act is celebrating its fifth anniversary and remains one of the most significant attempts to reform healthcare in US history. Prior to the federal legislation, Accountable Care Organizations had largely been part of an academic discussion about how to control rising healthcare costs, but have since become a fixture in our national healthcare landscape. A fundamental shift is underway in the relationship between healthcare delivery and payment models. Some elements of Accountable Care Organizations may remain unfamiliar to most healthcare providers, including neurointerventional specialists. In this paper we review the fundamental concepts behind and the current forms of Accountable Care Organizations, and discuss the challenges and opportunities they present for neurointerventionalists.


Assuntos
Organizações de Assistência Responsáveis/organização & administração , Reforma dos Serviços de Saúde , Neurorradiografia , Patient Protection and Affordable Care Act/organização & administração , Qualidade da Assistência à Saúde/normas , Radiologia Intervencionista/organização & administração , Organizações de Assistência Responsáveis/economia , Organizações de Assistência Responsáveis/normas , Custos de Cuidados de Saúde , Reforma dos Serviços de Saúde/economia , Reforma dos Serviços de Saúde/normas , Humanos , Neurorradiografia/economia , Neurorradiografia/normas , Patient Protection and Affordable Care Act/economia , Patient Protection and Affordable Care Act/normas , Qualidade da Assistência à Saúde/economia , Radiologia Intervencionista/economia , Radiologia Intervencionista/normas , Estados Unidos
17.
Acad Radiol ; 22(12): 1579-86, 2015 Dec.
Artigo em Inglês | MEDLINE | ID: mdl-26423205

RESUMO

RATIONALE AND OBJECTIVES: To identify and reduce reasons for delays in procedure start times, particularly the first cases of the day, within the interventional radiology (IR) divisions of the Department of Radiology using principles of continuous quality improvement. MATERIALS AND METHODS: An interdisciplinary team representative of the IR and preprocedure/postprocedure care area (PPCA) health care personnel, managers, and data analysts was formed. A standardized form was used to document both inpatient and outpatient progress through the PPCA and IR workflow in six rooms and to document reasons for delays. Data generated were used to identify key problems areas, implement improvement interventions, and monitor their effects. Project duration was 6 months. RESULTS: The average number of on-time starts for the first case of the day increased from 23% to 56% (P value < .01). The average number of on-time, scheduled outpatients increased from 30% to 45% (P value < .01). Patient wait time to arrive at treatment room once they were ready for their procedure was reduced on average by 10 minutes (P value < .01). Patient care delay duration per 100 patients was reduced from 30.3 to 21.6 hours (29% reduction). Number of patient care delays per 100 patients was reduced from 46.6 to 40.1 (17% reduction). Top reasons for delay included waiting for consent (26% of delays duration) and laboratory tests (12%). CONCLUSIONS: Many complex factors contribute to procedure start time delays within an IR practice. A data-driven and patient-centered, interdisciplinary team approach was effective in reducing delays in IR.


Assuntos
Melhoria de Qualidade , Serviço Hospitalar de Radiologia/organização & administração , Radiologia Intervencionista/organização & administração , Agendamento de Consultas , Humanos , Pacientes Internados/estatística & dados numéricos , Pacientes Ambulatoriais/estatística & dados numéricos , Cuidados Pós-Operatórios/normas , Cuidados Pré-Operatórios/normas , Serviço Hospitalar de Radiologia/normas , Serviço Hospitalar de Radiologia/estatística & dados numéricos , Radiologia Intervencionista/normas , Radiologia Intervencionista/estatística & dados numéricos , Fatores de Tempo , Fluxo de Trabalho
19.
J Am Coll Radiol ; 12(12 Pt A): 1337-44, 2015 Dec.
Artigo em Inglês | MEDLINE | ID: mdl-26337461

RESUMO

An important component of maintenance of certification and quality improvement in radiology is the practice quality improvement (PQI) project. In this article, the authors describe several methodologies for initiating and completing PQI projects. Furthermore, the authors illustrate several tools that are vital in compiling, analyzing, and presenting data in an easily understandable and reproducible manner. Last, they describe two PQI projects performed in an interventional radiology division that have successfully improved the quality of care for patients. Using the DMAIC (define, measure, analyze, improve, control) quality improvement framework, interventional radiology throughput has been increased, to lessen mediport wait times from 43 to 8 days, and mediport infection rates have decreased from more than 2% to less than 0.4%.


Assuntos
Competência Clínica , Administração da Prática Médica/organização & administração , Melhoria de Qualidade , Radiologia Intervencionista/organização & administração , Feminino , Humanos , Masculino , Inovação Organizacional , Desenvolvimento de Programas , Avaliação de Programas e Projetos de Saúde , Estados Unidos
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