Background: Medicine procedure services (MPSs) have been shown to increase procedure volume, procedure completion rate, adherence to best practice safety measures, resident involvement, and resident satisfaction, and decrease length of stay within Internal Medicine (IM) [Ref 1-4]. However, the frequency with which MPSs rely on other services, particularly Interventional Radiology (IR), for assistance to complete complex cases is unknown.
Purpose: As part of a process improvement project focused on reducing IR utilization to improve IR overcrowding and throughput, we assessed our escalation-to-IR rate for MPS-performed beside procedures including central venous lines (CVL), lumbar punctures (LP), paracenteses, and thoracenteses.
Description: To standardize the management of procedure requests for CVL, LP, paracentesis, and thoracentesis, our MPS and IR teams implemented a standard pathway to generally position the MPS as first-line operators. A formal escalation pathway was created for the MPS to obtain support from the IR team during or immediately after the procedure if the MPS encountered difficulty completing a procedure at the bedside. The type of assistance was dependent on IR workflow and MPS need. This agreement went live in August of 2024, and IR involvement was tracked using a standardized Epic Smartlist embedded within MPS consult notes that prompted faculty to select one of the following: • “No, IR involvement was not required” – if IR was not required. • “Yes, MPS recommended primary team consult IR for something we do not offer” – if the procedure requested was outside the MPS’s scope (e.g., tunneled central venous catheter). • “Yes, MPS recommended primary team consult IR for technical reasons” – if IR consult was advised due to technical issues (e.g. small windows with difficult positioning at bedside; anticipated challenging access for CVL). • “Yes, MPS worked with IR directly during or after the procedure” – if IR assistance was obtained to complete the procedure at bedside (e.g. difficulty advancing wire during CVL).From August 1st to October 31, 2024, a total of 748 procedures were completed under this protocol (Figure 1). Of these, 736 (98.4%) were managed solely by MPS without IR involvement, 6 (0.8%) required IR involvement for technical reasons, 4 (0.5%) involved direct collaboration with IR to complete the procedure, and 2 (0.25%) were referred to IR due to being outside MPS’s scope.
Conclusions: At our institution with an established, high-volume MPS, the escalation-to-IR rate was negligible. This may be useful to IM proceduralists, practice leaders, and hospital administrators weighing the costs and benefits of implementation of an MPS.
