- Email: [email protected]
Room for improvement: adherence to UAE standards of practice guidelines
MONDAY: Scientific Sessions
S90
’
Monday
Scientific Session
SIR-specified information as well as all relevant coding documentation in anticipation of future ICD-10 adoption. Standardized templates were then cross-mapped with corresponding procedure codes allowing auto-population upon dictation initiation. Results: Monthly coding addenda were reviewed pre- and post- standardized reporting template implementation. Preimplementation, the average number of monthly studies marked for review was 14.2 (range ¼ 3 – 31). During the four-month post-implementation period, the average number of monthly studies marked for review was 1.3 (range ¼ 0 – 2), a statistically significant reduction utilizing the unpaired t-test (p ¼ 0.004). Moreover, dictations marked for review utilizing the new reporting templates were subsequently analyzed and appropriate corrections made. Conclusions: Collaborative development of standardized reporting templates can dramatically reduce the number of required addenda thereby improving billing practices, staff workflow, and the quality and accuracy of interventional reporting. Ancillary benefits include the inclusion of relevant coding documentation for ICD-10 (laterality, chemoembolization history, etc.). Auto-population of common procedures also benefits new residents rotating through the division by providing a framework for each procedure and clearly delineating the necessary procedural information.
3:46 PM
’
JVIR
readmitted to a hospital due to pneumothorax, of which 66 (63.5%) required a chest tube. 60/104 patients (57.7%) were readmitted within 7 days of the procedure. Of the 104 readmissions, 55 (52.9%) were readmitted via the emergency department. Conclusions: Our results indicate that the incidence of delayed pneumothorax after lung biopsy is low (populationbased estimate o1%). The current standard for chest radiograph follow-up after lung biopsy appears to be sufficient and safe, resulting in few readmissions. However, delayed pneumothorax is still a possibility. Providers should follow up with a phone call after the procedure to prevent unnecessary visits to the emergency department. Further studies are needed to evaluate rates of delayed pneumothorax in other regions as well as refine the immediate follow-up algorithms. References 1. Perlmutt LM, Braun SD, Newman GE, Oke EJ, Dunnick NR. Timing of chest film follow-up after transthoracic needle aspiration. AJR Am J Roentgenol 1986; 146(5):1049–1050. 2. Choi CM, Um SW, Yoo CG, Kim YW, Han SK, Shim YS, Lee CT. Incidence and risk factors of delayed pneumothorax after transthoracic needle biopsy of the lung. Chest 2004; 126(5):1516–1521. 3. Dennie CJ, Matzinger FR, Marriner JR, Maziak DE. Transthoracic needle biopsy of the lung: results of early discharge in 506 outpatients. Radiology 2001; 219(1):247–251. 4. Byrd RP, Jr., Fields-Ossorio C, Roy TM. Delayed chest radiographs and the diagnosis of pneumothorax following CT-guided fine needle aspiration of pulmonary lesions. Respir Med 1999; 93(6):379–381.
Abstract No. 193
Delayed pneumothorax after percutaneous lung biopsy in the state of California B. Pua1, E. Tang2, A. Bhat3, R. Zabih3, R. Winokur1, D. Madoff1; 1Weill Cornell Medical College, New York, NY; 2Weill Cornell Imaging at NewYork-Presbyterian, New York, NY; 3Cornell University, New York, NY. Purpose: Percutaneous needle lung biopsy is a relatively safe and effective procedure that can be performed in outpatient settings. The most common complication is pneumothorax, which typically occurs immediately or within 30 minutes of the procedure.[1] However, delayed pneumothorax, especially those occurring after patients have been discharged, is of clinical concern. The incidence of delayed pneumothorax is not well known, varying from 1.4 to 4.5% based on select institution-based studies.[2-4] In this study, we determine the population-based estimate of delayed pneumothorax using discharge records in California. Materials: Using the Healthcare Cost and Utilization Project, Agency for Healthcare Research and Quality database, we tracked all patients who have undergone percutaneous needle lung biopsy in ambulatory care settings and were later admitted to a hospital with iatrogenic pneumothorax in California between 2006 and 2010. Percutaneous needle biopsy of the lung is defined by procedure code C32405, iatrogenic pneumothorax by D5121, and insertion of chest tube by P3404. Results: Between 2006 and 2010, 14,160 patients underwent a percutaneous needle lung biopsy in an ambulatory care setting in California. Median age was 70 and 45.2% were male (6.9% unknown). Among these 14,160 patients, 104 (0.7%) were
3:55 PM
Abstract No. 194
Room for improvement: adherence to UAE standards of practice guidelines N. Koney1, A. Friedman1, R. Dreifuss1, C. Moran2, J. Silberzweig3; 1Mount Sinai St Luke’s & Roosevelt Hospitals, New York, NY; 2North Shore Long Island Jewish, New York, NY; 3Mount Sinai Beth Israel Hospital, New York, NY. Purpose: Uterine artery embolization (UAE) has become a universally accepted treatment option for women with symptomatic leiomyoma since first reported in 1995 (1). With the recent FDA issued statement discouraging the use of surgical techniques that rely on morcellation devices due to risk of spreading cancer, there is increasing interest in, and scrutiny of, treatment options like UAE from referring colleagues and the general public (2). In 2014, SIR updated its quality improvement guidelines for UAE, with a focus on patient selection and informed consent (3, 4). According to the updated guidelines, with proper selection and informed consent, women who desire future pregnancy may undergo UAE. Furthermore, the risk of missed or delayed diagnosis of cancer should be included in informed consent. This study was performed to assess adherence to these guidelines and practice pattern variations. Materials: IRB exemption was obtained. A survey questionnaire designed to assess current practice patterns was approved by the SIR Standards of Practice Committee and distributed to post-residency SIR members in the United States and internationally (3,731 total) over a 2 week period in
JVIR
’
Scientific Session
Monday
June 2015. Fisher exact test and Z test were used to assess differences; a p-value of 0.05 was considered significant. Results: A total of 358 responses (9.6% response rate) was received. The majority were US based (330/358, 92%) and fellowship trained (332/358, 93%). Only 5% (14/262) of respondents felt that UAE was not safe for any women who desire future pregnancy. Roughly half (122/241, 51%) of respondents do not currently include the possibility of missed or delayed diagnosis of cancer in their informed consent process. Of those who discuss the risk, most quote a value of 1 in 1000 (69/241, 29%). Respondents with more experience were more likely to discuss risk of missed cancer compared to those with less experience (29/42, 69% for 15þ years vs 18/52, 35% for 0-5 years, po0.001). Conclusions: There is room for improvement in our informed consent process for UAE. All interventional radiologists, particularly the younger generation, should discuss the risk of missed or delayed diagnosis of cancer with patients. References
4:04 PM
Abstract No. 195
Interventional radiology clinic visit prior to outpatient Mediport placement improves patient satisfaction L. Brody1, J. Erinjeri1, R. Thornton2, S. Solomon3; 1 Memorial Sloan-Kettering Cancer Center, New York, NY; 2 N/A, Yorktown Heights, NY; 3N/A, New York, NY. Purpose: Patient preparation for mediport placement has historically been performed by referring clinicians. We sought to determine whether patient preparation / satisfaction could be improved by seeing patients in Interventional Radiology (IR) clinic prior to mediport placement. Materials and Methods: IRB approval was not required for this quality assurance study. Patients from predefined referring clinics were seen in IR clinic prior to mediport placement. An IR RN was responsible for education and preparation for this group. Teaching and preparation for all other patients was the responsibility of the referring clinic. From 11/5/13 – 1/3/14, all patients undergoing outpatient mediport placement by the IR service were asked to complete a short survey prior to the procedure; most questions utilized a 5-point Likert scale. Univariate and multivariate analysis was performed to determine whether IR clinic affected patient satisfaction and perceived preparedness. Results: 49 patients were seen IR clinic, with referring clinics responsible for 105. Patients prepared by IR were significantly more likely to feel that: their questions were answered
S91
(po0.0018); they received education materials (po0.0002); they knew how to care for their wound (po0.0013); their instructions were clear (po0.0002); and the procedure was easy to schedule (po0.0002). Overall satisfaction with scheduling, teaching and preparation was also significantly better (po0.01). Having all questions answered and ease of scheduling were the strongest independent predictors of overall satisfaction (OR 2.2 and 2.0 respectively). Conclusions: Despite an extra clinic visit, patients undergoing OP mediport placement were significantly more satisfied with scheduling, teaching and preparation when these tasks were performed by IR staff. References 1. Lutjeboer J, Burgman MC, Chung K, van Erkel AR. Impact on Patient’s Safety and Satisfaction of Instrumentation of an Outpatient Clinic in Interventional Radiology (IPSIPOLI-Study): A Quasi-Experimental Prospective Study. CVIR 2015; 38:543–551. 2. Swichuk J, Sacks D, Pentecost M, et al. Clinical practice of interventional and cardiovascular radiology: Current Status, Guidelines for Resource Allocation, Future Directions. J Am Coll Radiol 2004; 1:720–727.
4:13 PM
Abstract No. 196
Using LEAN principles to integrate the vascular team into ED and inpatient vascular study reporting: impact on length-of-stay and hospitalization cost A. Bhakoo, B. Olivieri, R. Beasley; Mount Sinai Medical Center, Miami Beach, FL. Purpose: To evaluate the impact of using LEAN principles in peripheral vascular study reporting to reduce hospitalization length of stay and cost for PAD patients. Materials: Materials: Data from a quality improvement project to expedite initiation of patient care on PAD patients through prompt communication with physicians who routinely consult the multidisciplinary vascular/wound healing team led by the VIR Division at our hospital. Methodology: Comparison was made of time from study completion to vascular consult and to discharge for two patient groups; those whose physicians were notified by VIR of the findings at study completion (n¼28) and those whose physicians consulted VIR/vascular specialists without early notification (n¼47). Cohort-match analysis (based on Rutherford classification) comparing the average time to vascular consult and average time to discharge in the two groups of patients was performed. Inclusion criteria: All ER and inpatients referred to vascular specialists within our hospital for PAD management following an ultrasound from 11/2013 through 4/2015. Exclusion criteria: Patients with a concomitant acute medical problem during admission, ex: ACS, cholecystitis. Hospital Adjusted Expenses per inpatient day was obtained from the latest Kaiser Family Foundation data for nonprofit hospitals in our state. Results: Data was first analyzed for statistical significance using t-tests for each dependent variable and found to be significant with p-values of 0.03. For all Rutherford classes, the data demonstrates that earlier communication from an integrated vascular team for positive studies decreases time to consult with decreased time to discharge and cost savings.
MONDAY: Scientific Sessions
1. Ravina J, Ciraru-Vigneron N, Bouret J, et al. Arterial embolisation to treat uterine myomata. The Lancet. 1995; 346(8976):671–672. 2. McCarthy M. US agency warns against morcellation in hysterectomies and myomectomies. BMJ. 2014; 348:g2872. 3. Dariushnia SR, Nikolic B, Stokes LS, Spies JB, Society of Interventional Radiology Standards of Practice Committee. Quality improvement guidelines for uterine artery embolization for symptomatic leiomyomata. J Vasc Interv Radiol. 2014; 25(11):1737–1747. 4. Stokes LS, Wallace MJ, Godwin RB, Kundu S, Cardella JF, Society of Interventional Radiology Standards of Practice Committee. Quality improvement guidelines for uterine artery embolization for symptomatic leiomyomas. J Vasc Interv Radiol. 2010; 21(8):1153–1163.
’
S90
’
Monday
Scientific Session
SIR-specified information as well as all relevant coding documentation in anticipation of future ICD-10 adoption. Standardized templates were then cross-mapped with corresponding procedure codes allowing auto-population upon dictation initiation. Results: Monthly coding addenda were reviewed pre- and post- standardized reporting template implementation. Preimplementation, the average number of monthly studies marked for review was 14.2 (range ¼ 3 – 31). During the four-month post-implementation period, the average number of monthly studies marked for review was 1.3 (range ¼ 0 – 2), a statistically significant reduction utilizing the unpaired t-test (p ¼ 0.004). Moreover, dictations marked for review utilizing the new reporting templates were subsequently analyzed and appropriate corrections made. Conclusions: Collaborative development of standardized reporting templates can dramatically reduce the number of required addenda thereby improving billing practices, staff workflow, and the quality and accuracy of interventional reporting. Ancillary benefits include the inclusion of relevant coding documentation for ICD-10 (laterality, chemoembolization history, etc.). Auto-population of common procedures also benefits new residents rotating through the division by providing a framework for each procedure and clearly delineating the necessary procedural information.
3:46 PM
’
JVIR
readmitted to a hospital due to pneumothorax, of which 66 (63.5%) required a chest tube. 60/104 patients (57.7%) were readmitted within 7 days of the procedure. Of the 104 readmissions, 55 (52.9%) were readmitted via the emergency department. Conclusions: Our results indicate that the incidence of delayed pneumothorax after lung biopsy is low (populationbased estimate o1%). The current standard for chest radiograph follow-up after lung biopsy appears to be sufficient and safe, resulting in few readmissions. However, delayed pneumothorax is still a possibility. Providers should follow up with a phone call after the procedure to prevent unnecessary visits to the emergency department. Further studies are needed to evaluate rates of delayed pneumothorax in other regions as well as refine the immediate follow-up algorithms. References 1. Perlmutt LM, Braun SD, Newman GE, Oke EJ, Dunnick NR. Timing of chest film follow-up after transthoracic needle aspiration. AJR Am J Roentgenol 1986; 146(5):1049–1050. 2. Choi CM, Um SW, Yoo CG, Kim YW, Han SK, Shim YS, Lee CT. Incidence and risk factors of delayed pneumothorax after transthoracic needle biopsy of the lung. Chest 2004; 126(5):1516–1521. 3. Dennie CJ, Matzinger FR, Marriner JR, Maziak DE. Transthoracic needle biopsy of the lung: results of early discharge in 506 outpatients. Radiology 2001; 219(1):247–251. 4. Byrd RP, Jr., Fields-Ossorio C, Roy TM. Delayed chest radiographs and the diagnosis of pneumothorax following CT-guided fine needle aspiration of pulmonary lesions. Respir Med 1999; 93(6):379–381.
Abstract No. 193
Delayed pneumothorax after percutaneous lung biopsy in the state of California B. Pua1, E. Tang2, A. Bhat3, R. Zabih3, R. Winokur1, D. Madoff1; 1Weill Cornell Medical College, New York, NY; 2Weill Cornell Imaging at NewYork-Presbyterian, New York, NY; 3Cornell University, New York, NY. Purpose: Percutaneous needle lung biopsy is a relatively safe and effective procedure that can be performed in outpatient settings. The most common complication is pneumothorax, which typically occurs immediately or within 30 minutes of the procedure.[1] However, delayed pneumothorax, especially those occurring after patients have been discharged, is of clinical concern. The incidence of delayed pneumothorax is not well known, varying from 1.4 to 4.5% based on select institution-based studies.[2-4] In this study, we determine the population-based estimate of delayed pneumothorax using discharge records in California. Materials: Using the Healthcare Cost and Utilization Project, Agency for Healthcare Research and Quality database, we tracked all patients who have undergone percutaneous needle lung biopsy in ambulatory care settings and were later admitted to a hospital with iatrogenic pneumothorax in California between 2006 and 2010. Percutaneous needle biopsy of the lung is defined by procedure code C32405, iatrogenic pneumothorax by D5121, and insertion of chest tube by P3404. Results: Between 2006 and 2010, 14,160 patients underwent a percutaneous needle lung biopsy in an ambulatory care setting in California. Median age was 70 and 45.2% were male (6.9% unknown). Among these 14,160 patients, 104 (0.7%) were
3:55 PM
Abstract No. 194
Room for improvement: adherence to UAE standards of practice guidelines N. Koney1, A. Friedman1, R. Dreifuss1, C. Moran2, J. Silberzweig3; 1Mount Sinai St Luke’s & Roosevelt Hospitals, New York, NY; 2North Shore Long Island Jewish, New York, NY; 3Mount Sinai Beth Israel Hospital, New York, NY. Purpose: Uterine artery embolization (UAE) has become a universally accepted treatment option for women with symptomatic leiomyoma since first reported in 1995 (1). With the recent FDA issued statement discouraging the use of surgical techniques that rely on morcellation devices due to risk of spreading cancer, there is increasing interest in, and scrutiny of, treatment options like UAE from referring colleagues and the general public (2). In 2014, SIR updated its quality improvement guidelines for UAE, with a focus on patient selection and informed consent (3, 4). According to the updated guidelines, with proper selection and informed consent, women who desire future pregnancy may undergo UAE. Furthermore, the risk of missed or delayed diagnosis of cancer should be included in informed consent. This study was performed to assess adherence to these guidelines and practice pattern variations. Materials: IRB exemption was obtained. A survey questionnaire designed to assess current practice patterns was approved by the SIR Standards of Practice Committee and distributed to post-residency SIR members in the United States and internationally (3,731 total) over a 2 week period in
JVIR
’
Scientific Session
Monday
June 2015. Fisher exact test and Z test were used to assess differences; a p-value of 0.05 was considered significant. Results: A total of 358 responses (9.6% response rate) was received. The majority were US based (330/358, 92%) and fellowship trained (332/358, 93%). Only 5% (14/262) of respondents felt that UAE was not safe for any women who desire future pregnancy. Roughly half (122/241, 51%) of respondents do not currently include the possibility of missed or delayed diagnosis of cancer in their informed consent process. Of those who discuss the risk, most quote a value of 1 in 1000 (69/241, 29%). Respondents with more experience were more likely to discuss risk of missed cancer compared to those with less experience (29/42, 69% for 15þ years vs 18/52, 35% for 0-5 years, po0.001). Conclusions: There is room for improvement in our informed consent process for UAE. All interventional radiologists, particularly the younger generation, should discuss the risk of missed or delayed diagnosis of cancer with patients. References
4:04 PM
Abstract No. 195
Interventional radiology clinic visit prior to outpatient Mediport placement improves patient satisfaction L. Brody1, J. Erinjeri1, R. Thornton2, S. Solomon3; 1 Memorial Sloan-Kettering Cancer Center, New York, NY; 2 N/A, Yorktown Heights, NY; 3N/A, New York, NY. Purpose: Patient preparation for mediport placement has historically been performed by referring clinicians. We sought to determine whether patient preparation / satisfaction could be improved by seeing patients in Interventional Radiology (IR) clinic prior to mediport placement. Materials and Methods: IRB approval was not required for this quality assurance study. Patients from predefined referring clinics were seen in IR clinic prior to mediport placement. An IR RN was responsible for education and preparation for this group. Teaching and preparation for all other patients was the responsibility of the referring clinic. From 11/5/13 – 1/3/14, all patients undergoing outpatient mediport placement by the IR service were asked to complete a short survey prior to the procedure; most questions utilized a 5-point Likert scale. Univariate and multivariate analysis was performed to determine whether IR clinic affected patient satisfaction and perceived preparedness. Results: 49 patients were seen IR clinic, with referring clinics responsible for 105. Patients prepared by IR were significantly more likely to feel that: their questions were answered
S91
(po0.0018); they received education materials (po0.0002); they knew how to care for their wound (po0.0013); their instructions were clear (po0.0002); and the procedure was easy to schedule (po0.0002). Overall satisfaction with scheduling, teaching and preparation was also significantly better (po0.01). Having all questions answered and ease of scheduling were the strongest independent predictors of overall satisfaction (OR 2.2 and 2.0 respectively). Conclusions: Despite an extra clinic visit, patients undergoing OP mediport placement were significantly more satisfied with scheduling, teaching and preparation when these tasks were performed by IR staff. References 1. Lutjeboer J, Burgman MC, Chung K, van Erkel AR. Impact on Patient’s Safety and Satisfaction of Instrumentation of an Outpatient Clinic in Interventional Radiology (IPSIPOLI-Study): A Quasi-Experimental Prospective Study. CVIR 2015; 38:543–551. 2. Swichuk J, Sacks D, Pentecost M, et al. Clinical practice of interventional and cardiovascular radiology: Current Status, Guidelines for Resource Allocation, Future Directions. J Am Coll Radiol 2004; 1:720–727.
4:13 PM
Abstract No. 196
Using LEAN principles to integrate the vascular team into ED and inpatient vascular study reporting: impact on length-of-stay and hospitalization cost A. Bhakoo, B. Olivieri, R. Beasley; Mount Sinai Medical Center, Miami Beach, FL. Purpose: To evaluate the impact of using LEAN principles in peripheral vascular study reporting to reduce hospitalization length of stay and cost for PAD patients. Materials: Materials: Data from a quality improvement project to expedite initiation of patient care on PAD patients through prompt communication with physicians who routinely consult the multidisciplinary vascular/wound healing team led by the VIR Division at our hospital. Methodology: Comparison was made of time from study completion to vascular consult and to discharge for two patient groups; those whose physicians were notified by VIR of the findings at study completion (n¼28) and those whose physicians consulted VIR/vascular specialists without early notification (n¼47). Cohort-match analysis (based on Rutherford classification) comparing the average time to vascular consult and average time to discharge in the two groups of patients was performed. Inclusion criteria: All ER and inpatients referred to vascular specialists within our hospital for PAD management following an ultrasound from 11/2013 through 4/2015. Exclusion criteria: Patients with a concomitant acute medical problem during admission, ex: ACS, cholecystitis. Hospital Adjusted Expenses per inpatient day was obtained from the latest Kaiser Family Foundation data for nonprofit hospitals in our state. Results: Data was first analyzed for statistical significance using t-tests for each dependent variable and found to be significant with p-values of 0.03. For all Rutherford classes, the data demonstrates that earlier communication from an integrated vascular team for positive studies decreases time to consult with decreased time to discharge and cost savings.
MONDAY: Scientific Sessions
1. Ravina J, Ciraru-Vigneron N, Bouret J, et al. Arterial embolisation to treat uterine myomata. The Lancet. 1995; 346(8976):671–672. 2. McCarthy M. US agency warns against morcellation in hysterectomies and myomectomies. BMJ. 2014; 348:g2872. 3. Dariushnia SR, Nikolic B, Stokes LS, Spies JB, Society of Interventional Radiology Standards of Practice Committee. Quality improvement guidelines for uterine artery embolization for symptomatic leiomyomata. J Vasc Interv Radiol. 2014; 25(11):1737–1747. 4. Stokes LS, Wallace MJ, Godwin RB, Kundu S, Cardella JF, Society of Interventional Radiology Standards of Practice Committee. Quality improvement guidelines for uterine artery embolization for symptomatic leiomyomas. J Vasc Interv Radiol. 2010; 21(8):1153–1163.
’