Providing access to interventionalradiology services, seven days a week
Improving QualityNHS
British Society of Interventional Radiology
ContentsForeword
Executive summary
Introduction
Economic benefits
The Sheffield Experience
Focus on procedures
3
4
5
8
9
10
12
19
21
22
24
25
26
National picture - whereare we now and where arewe going?
Emerging themes
Appendix A
Appendix B
References
Contacts
Glossary
More than ever before, the NHS is attempting to focus care around theneeds of our patients, ensuring we offer them a safe environment inwhich to receive care and treatment, irrespective of the point in thepatient’s journey or indeed the day that they require that care.
To this end we are looking at whole pathways of care across the system that may crossboth organisational boundaries, or between different types of provision across the healthand social care system.
Providing access to Interventional Radiology services, seven days a week pulls together theresponses from three annual national Interventional Radiology (IR) surveys and intelligencegathering from across England. NHS Improving Quality have reviewed IR services acrossthe country and confirmed that more improvement work is necessary to ensure equitableaccess to IR services for patients seven days a week (1).
Cutting across several clinical specialties this report explores some of the issues andchallenges in delivering high quality IR services both nationally and locally and seeks toshare good practice and innovations around novel delivery models. It provides practicalguidance for assessing your own service as well as service improvement ideas that somenetworks have adopted, which could be adapted to improve services further.The core purpose of this publication is to highlight key features that constitute a safe andeffective IR service. I recommend that you use it to review the IR services you provide orcommission to ensure delivery of an effective and sustainable IR service.
Professor Erika Denton FRCP, FRCRNational Clinical Director for Diagnostics, NHS England
Professor Duncan Ettles MB ChB (Hons), MD, FRCP (Ed), FRCRPresident, British Society of Interventional Radiology
Foreword by Professor Erika Dentonand Professor Duncan Ettles
Foreword 3
Interventional radiologyprocedures are low volume andhave a number of complexchallenges. The serviceconfiguration at each Trust differsand is dependent on the numberand the skill mix of interventionalradiology consultants in the Trust.It is a service that supports a widerange of clinical pathways.
Based on the work of the NHSEngland Seven Day ServicesForum and NHS ImprovingQuality’s Seven Day ServicesImprovement Programme (SDSIP),the focus for the 2013/14interventional radiologyprogramme has been to developnetworks to deliver seven dayaccess for nephrostomy,embolisation for haemorrhageand embolisation for post-partumhaemorrhage. Nephrostomy is acore interventional radiologyservice required for patients witha potential to deteriorate andrequire urgent intervention.Embolisation for haemorrhageusually, but not exclusively, isperformed as an emergency/urgent intervention.Embolisation for post-partumhaemorrhage may involve pre-delivery planning and beperformed as an emergency/urgent intervention.
Executive summary
4 Executive summary
High quality interventional radiology services areessential for safe and effective patient care
There is variation in the provision of interventionalradiology throughout England, particularly forpotentially lifesaving emergency and out of hoursprocedures
Networked delivery models will be essential to improveaccess to interventional radiology. There are challengesin developing effective operational delivery networks,primarily due to the shortfall in the recruitment ofconsultant interventional radiologists
A good well resourced interventional radiology servicecan contribute to significant savings (both financial andnon-financial), as well as improve patient outcomes alongcare pathways in both planned and emergency care. (Seeexample of interventional radiology impact forperipheral vascular disease in diabetic patients)
Understand your current service provision to support yourimprovement efforts (see Appendix B for suggested baselining templates)
KEY MESSAGES
Introduction 5
Interventional radiology is acomparatively new sub-specialtyof radiology, sometimes knownas ‘surgical radiology’. It is oftenmistakenly viewed as a purelydiagnostic radiology servicewhere patients and the clinicalcommunity are commonlyunaware of the benefits ofinterventional radiologytreatments. The proceduresrequire the use of imagingtechniques to guideinterventional instruments intoblood vessels and organs, todiagnose and treat a wide rangeof clinical conditions. Theseinnovative techniques can oftenprovide patients with a bettertreatment option to conservativemanagement or surgery, as thetechniques are minimally invasiveand reduce the physical traumato the patient and the infectionrisk, therefore, enabling thepatient to have an easier andfaster recovery often as a daycase. Interventional radiologyinterventions can also be highlybeneficial in urgent andemergency situations.
Diagnostic radiologists sometimesperform some of the simpleimage guided procedures such asnephrostomy and abscessdrainage, but interventional
Introduction
radiologists are sub-specialistswho perform the wider range ofinterventional procedures.Interventional radiologists arealso often required to work inclinical sub-specialties, whichmean that skill mix and numbersof interventional radiologistsavailable in each specialty can belimited as there is a nationalshortage of interventionalradiologists nationally, and thiscan hinder the level of service anacute hospital can provide.
In December 2013, NHS Englandpublished Everyone Counts:Planning for patients 2014/15 to2018/19 (2). It included a numberof offers to NHS commissioners,to give them the insights andevidence they need to producebetter local health outcomes. Itstated, that the NHS will movetowards routine services beingavailable seven days a week. It issupported by; Towards BestPractice in InterventionalRadiology (NHS Improvement,2012)(3) , which sets out casestudies using interventionalradiology service delivery modelsthat provide benefits for patientsand staff.
To support seven day woking, the National Medical Director,
Professor Sir Bruce Keogh,established the NHS Services,Seven Days a Week Forum, toconsider the consequences of thenon-availability of clinical servicesacross the seven day week, andprovide proposals forimprovements to anyshortcomings. The Forum hasestablished thematic workstreamswhich include clinical standardsthat specifically relate todiagnostics and intervention/keyservices.
6 Introduction
The supporting information forStandard 5 Diagnostics states,‘where a service is not availableon site (e.g. InterventionalRadiology / Endoscopy orMagnetic Resonance Imaging(MRI) clear patient pathwaysmust be in place betweenproviders.’
Standard 6 Intervention/KeyServices states, ‘Hospitalinpatients must have timely 24hour access, seven days a week,to consultant-directedinterventions that meet therelevant specialty guidelines,either on-site or through formallyagreed networked arrangementswith clear protocols, such as:
• Critical care • Interventional radiology • Interventional endoscopy • Emergency general surgery.
To support this, NHS ImprovingQuality’s 2013/14 InterventionalRadiology ImprovementProgramme has focused onfacilitating the development ofinterventional radiology networksand the completion of the thirdannual national interventionalradiology survey.
This has been with the support ofthe British Society of InterventionalRadiology (BSIR) and the BSIRSafety and Quality Group. TheBSIR has representation from theMedicines and Healthcare productsRegulatory Agency (MHRA) andthe Society of InterventionalRadiology Nurses andRadiographers. Whilst promotingbest practice, the BSIR has alsoidentified 15 exemplar sites acrossthe UK based on an agreed set ofquality standards (4).
Diagnostic standards
Introduction 7
NICE Guideline (CG119): Management of Diabetic Foot
NICE Guideline (CG141): Acute upper gastrointestinal bleeding overview
NICE Guideline (CG147): Lower limb peripheral arterial disease
NICE Guideline (IPG127): Endovascular stent-graft placement in thoracic aorticaneurysms and dissections
DH Clinical Policy: Cardiovascular Disease Outcomes Strategy
The Role of Emergency and Elective Interventional Radiology in PostpartumHaemorrhage (Good Practice No. 6), Royal College of Obstetricians andGynaecologists (2007)
Investigation into 10 maternal deaths at, or following delivery at, Northwick ParkHospital, North West London Hospitals NHS Trust, between April 2002 and April 2005,Healthcare Commission (2006)
Interventional Radiology: Improving Outcomes and Quality for Patients (Departmentof Health, 2009) and Interventional Radiology: a guide to service delivery(Department of Health, 2010) Annex C Adverse events
The NHS Atlas of Variation in Diagnostic Services (NHS and Public Health England,2013) www.rightcare.nhs.uk/index.php/atlas/diagnostics-the-nhs-atlas-of-variation-in-diagnostics-services
CASE FOR CHANGE
8 The Sheffield Experience
By using early re-vascularisation andinterventional radiology proceduresinstead of conservative management,Sheffield experienced a 70% reductionin the amputation rate. Referral
VS or IR ifrest pain
Diabetes ward
Assessment
Imaging MDT
MDT
Day case
Follow up
Wounddebridement
Follow up
Assessment
Patient pathway
VS - Vascular SurgeryIR - Interventional RadiologyMDT - Multidisciplinary team
The Sheffield Experience
Economic benefits 9
The clinical and economical value ofearly re-vascularisation for peripheralvascular disease in diabetic patients.
Burden of disease in the UK(diabetes 5% prevalence)
Diabetic population
Diabetics with peripheral vascular disease
Amputations - diabetic patients
Comparison of lower limb amputation rate indiabetic population
UK
Germany
Italy
Comparison of procedures and hospital costs
Angioplasty (IR)
Stenting (IR)
By-pass (surgery)
Amputation (surgery)
Population size
3,380,684
676,131
8,684
Percentage rate
0.26%
0.21% (UK 38% higher)
0.16% (UK 17% higher)
£1898
£2393
£6460
£12,075
Economic benefits
10 Focus on procedures
Procedure
1) Nephrostomy
2) Embolisation for haemorrhage
3) Embolisation for post-partum haemorrhage
Descriptor
An artificial opening created between thekidney and the skin used to drain urine fromthe kidney to a bag outside the body
A minimally invasive procedure which involvesthe selective occlusion of blood vessels toprevent haemorrhage
A minimally invasive procedure which involvesthe selective occlusion of blood vessels toprevent haemorrhage in childbirth
Focus on procedures
Possible patient pathways - where interventional radiology procedures could be utilised
Acute renalSepsis Chronic renal failure
OBSTRUCTED KIDNEY
Retrograde stenting
(urologist)Nephrostomy
(IR)Retrograde
stenting (urologist)
E!ective group
Nephrostomy(IR)
SurgeryD&C balloonMedical treatment
Embolisation(IR)
POSTPARTUM HAEMORRHAGE
IR - Interventional Radiology
Focus on procedures 11
IR - Interventional Radiology
Endoscopy(negative)Endoscopy (positive)
Therapeutic endoscopydependant on skills
of operator
Embolisation (IR)
CT angiogram
Repeat endoscopy
UPPER GASTROINTESTINAL HAEMORRHAGE
Failure at thisstage may trigger
referral to IR
Patientunstable
Patient stable/controlled resuscitation
Colonoscopy
Bleeding source identi!ed
LOWER GASTROINTESTINAL HAEMORRHAGE
Bleeding source not identi!ed
Resuscitation
Urgent Colonoscopy +/- and OGD
LaparotomyConservative
treatmentSurgery IR CT scan
Negative Bleeding sourceidenti!ed
Angiography ifbleeding continues
IR
Surgery (if IR fails)
Surgery (if IR fails)
12 National picture - where are we now and where are we going?
A third annual interventionalradiology survey of all hospitalsin England, to demonstrate thelevel of access to 24/7interventional radiology serviceswas conducted in Autumn2013. The survey focused onthe 3 procedures (nephrostomy,embolisation for haemorrhageand post-partum haemorrhage),plus endovascular intervention(covering other coreinterventional radiologyprocedures). The selfassessment results confirmedimprovements in the 24 hour
service provision for 2 of the 3key procedures, nephrostomyand embolisation forhaemorrhage, as well as forendovascular intervention(covering other coreinterventional radiologyprocedures), and provided abase line for embolisation forpost-partum haemorrhage.Further improvements areexpected throughout 2014having gained an insight intoTrusts’ annual interventionalradiology plans.
National picture - where are we nowand where are we going?
Interventional radiology survey 2013
National picture - where are we now and where are we going? 13
National RAG status for nephrostomy
Nephrostomy in hours service provision 2012
KEY
GREEN: Core serviceprovision on site or formalnational pathways to anagreed recipient trust
RED: No core serviceprovision
WHITE: No data
Data as at 10 January 2014Number of responses = 151 out of 151100% response rate over 2011/2012
KEY
GREEN: Core serviceprovision on site or formalnational pathways to anagreed recipient trust
AMBER: Plan in place toprovide service/formalpathway within the next 12months
RED: No core serviceprovision and no plans toprovide in the next 12months
WHITE: No data
Data as at 10 January 2014Number of responses = 122 out of 151100% response rate over 2011/2012
Nephrostomy in hours service provision 2013
Nephrostomy out of hours service provision 2012
KEY
GREEN: Core serviceprovision on site or formalnational pathways to anagreed recipient trust
RED: No core serviceprovision
WHITE: No data
Data as at 10 January 2014Number of responses = 151 out of 151100% response rate over 2011/2012
KEY
GREEN: Core serviceprovision on site or formalnational pathways to anagreed recipient trust
AMBER: Plan in place toprovide service/formalpathway within the next 12months
RED: No core serviceprovision and no plans toprovide in the next 12months
WHITE: No data
Data as at 10 January 2014Number of responses = 122 out of 151100% response rate over 2011/2012
Nephrostomy out of hours service provision 2013
14 National picture - where are we now and where are we going?
National RAG status for embolisation for haemorrhage
Embolisation for haemorrhage: general in hours service provision 2012
KEY
GREEN: Core serviceprovision on site or formalnational pathways to anagreed recipient trust
RED: No core serviceprovision
WHITE: No data
Data as at 10 January 2014Number of responses = 151 out of 151100% response rate over 2011/2012
KEY
GREEN: Core serviceprovision on site or formalnational pathways to anagreed recipient trust
AMBER: Plan in place toprovide service/formalpathway within the next 12months
RED: No core serviceprovision and no plans toprovide in the next 12months
WHITE: No data
Data as at 10 January 2014Number of responses = 122 out of 151100% response rate over 2011/2012
Embolisation for haemorrhage: general in hours service provision 2013
Embolisation for haemorrhage: general out of hours service provision 2012
KEY
GREEN: Core serviceprovision on site or formalnational pathways to anagreed recipient trust
RED: No core serviceprovision
WHITE: No data
Data as at 10 January 2014Number of responses = 151 out of 151100% response rate over 2011/2012
KEY
GREEN: Core serviceprovision on site or formalnational pathways to anagreed recipient trust
AMBER: Plan in place toprovide service/formalpathway within the next 12months
RED: No core serviceprovision and no plans toprovide in the next 12months
WHITE: No data
Data as at 10 January 2014Number of responses = 122 out of 151100% response rate over 2011/2012
Embolisation for haemorrhage: general out of hours service provision 2013
National picture - where are we now and where are we going? 15
National RAG status for endovascular intervention
Endovascular intervention in hours service provision 2012
KEY
GREEN: Core serviceprovision on site or formalnational pathways to anagreed recipient trust
RED: No core serviceprovision
WHITE: No data
Data as at 10 January 2014Number of responses = 151 out of 151100% response rate over 2011/2012
KEY
GREEN: Core serviceprovision on site or formalnational pathways to anagreed recipient trust
AMBER: Plan in place toprovide service/formalpathway within the next 12months
RED: No core serviceprovision and no plans toprovide in the next 12months
WHITE: No data
Data as at 10 January 2014Number of responses = 122 out of 151100% response rate over 2011/2012
Endovascular intervention in hours service provision 2013
Endovascular intervention out of hours service provision 2012
KEY
GREEN: Core serviceprovision on site or formalnational pathways to anagreed recipient trust
RED: No core serviceprovision
WHITE: No data
Data as at 10 January 2014Number of responses = 151 out of 151100% response rate over 2011/2012
KEY
GREEN: Core serviceprovision on site or formalnational pathways to anagreed recipient trust
AMBER: Plan in place toprovide service/formalpathway within the next 12months
RED: No core serviceprovision and no plans toprovide in the next 12months
WHITE: No data
Data as at 10 January 2014Number of responses = 122 out of 151100% response rate over 2011/2012
Endovascular intervention out of hours service provision 2013
16 National picture - where are we now and where are we going?
National RAG status for postpartum haemorrhage
Embolisation for postpartum haemorrhagein hours service provision 2013
KEY
GREEN: Core serviceprovision on site or formalnational pathways to anagreed recipient trust
AMBER: Plan in place toprovide service/formalpathway within the next 12months
RED: No core serviceprovision and no plans toprovide in the next 12months
WHITE: No data
Data as at 10 January 2014Number of responses = 122 out of 151100% response rate over 2011/2012
KEY
GREEN: Core serviceprovision on site or formalnational pathways to anagreed recipient trust
AMBER: Plan in place toprovide service/formalpathway within the next 12months
RED: No core serviceprovision and no plans toprovide in the next 12months
WHITE: No data
Data as at 10 January 2014Number of responses = 122 out of 151100% response rate over 2011/2012
Embolisation for postpartum haemorrhage out of hours service provision 2013
The national survey askedproviders what they consideredto be the rate limiting step innot providing a comprehensiveinterventional radiology service.
Rate limiting factors for not deliveringservice at present time (England)
New interventionalradiology facility5%
Interventionalradiologistappointments22%
Interventional nurse appointments18%
Interventionalnurse rota19%
Interventionalradiographer rota17%
Network approachto service delivery19%
National picture - where are we now and where are we going? 17
Delivering and sustaining 24 hour interventionalradiology services - percentage units providing24 hour service cover for key procedures
The survey also askedinterventional radiology servicesto comment on whether theywere planning to deliver servicechanges within the next 12months. Encouragingly it wasthe intention of many servicesto deliver more comprehensiveservice delivery models.However, considering the ratelimiting steps as described byproviders, it would require afurther survey to determinewhether they are successful intheir ambitions.
90%
80%
70%
60%
50%
40%
30%2012 2013 Next 12 months
Nephrostomy
Embolism forhaemorrhage - general
Endovascularintervention
Embolisation forpostpartumhaemorrhage
The development of networkedapproaches and solutions withfive regions in England hasfocused on the comprehensivebaselining of services. Templatesto support such work can befound in Appendix B, enablingproviders to progress withdefining and formalisingpathways of care to ensurepatients have access tointerventional radiology services,seven days a week. Strongcollaborative working betweenTrusts and good practiceexamples were particularlyevident within the East Midlandsnetwork, where work isunderway to address many ofthe challenges faced byinterventional radiology serviceproviders, such as therecruitment and retention ofconsultant interventionalradiology radiologists.
18 National picture - where are we now and where are we going?
Networking
Facilities andprocesses
Funding
Staffing andteam working
Example 1
Joint appointments forinterventional radiologyvascular consultant(s) and/orvascular surgeon(s), tosupport 1 in 6 rota standardsfor vascular services
4 dedicated beds in a daycase area located in thedepartment allowing directpatient observation andcorrect income allocation
Focus on cost benefits ofinterventional radiologyprocedures, with good inter-department support fromdata managers in renal,vascular and neurologicaldisciplines, allowing forpatient and consultant levelcosting
Well developed competencyassessment framework forconsultants, radiographersand nurses to support roledevelopment and skill mixutilisation
Example 2
Formal pathways in placefor referral of specialistand generic interventionalradiology work to othercentre
Pre assessment donejointly by interventionalradiology and vascularstaff utilising a dedicatedconsulting room in thedepartment
Example 3
Links with local commissioners on increase in demand forendovascular aneurysm repair(EVAR) and fenestrated EVAR(FEVAR) and new ClinicalCommissioning Policy forendovascular stent grafts inabdominal aortic aneurysm
Standardised interventionalradiology kit at two sites withinthe same Trust to support standardworking and to facilitate cross siteworking
Collaborative working and best practice examples from East Midlands Network
Emerging themes 19
Based on the work throughout2013/14, the following emergingthemes were identified fordelivering seven dayinterventional radiology services,to support the NHS Services,Seven Days a Week Forum:
1. Patient safety/Adverseevents – The interventionalradiology adverse events (March2013 - see Case for Change andAppendix A) are serviceaspirations and althoughendorsed by the BSIR they are notincluded in the 25 Never Events,which are reportable incidents forTrusts. There appears to bevariation in the knowledge andunderstanding of theinterventional radiology adverseevents throughout England.
2. Workforce – The Centre forWorkforce Intelligence report(December 2012) states that thenational gap in interventionalradiology consultant posts is inexcess of 220 in England. Presenttraining numbers will not meetthis deficit. Interventionalradiology training programmesare less formalised than otherspecialities, with recruitmentfrom a pool of radiology trainees.European interventional radiologyrecruitment is underway buttraining in Europe is very different
Emerging themes
to the English/UK system andcandidates require intensivetraining and supervision. This‘sellers’ market means that theinterventional radiologyradiologist workforce is verymobile which creates serviceinstability, particularly in ‘hard torecruit to’ locations. Some Trustshave secured joint interventionalradiology consultantappointments or are exploringthe potential for jointappointments as a solution to thenational recruitment issue. Inaddition, the skills of individualinterventional radiologyconsultants in Trusts oftendetermine the services delivered,rather than a service based onpopulation need.
3. Commissioning and finance– There is variation inunderstanding that interventionalradiology can deliver a costeffective, safe and alternativeservice to more invasiveprocedures such as surgery. Tarifffor interventional radiologyprocedures is not unbundled andcoding is often an issue forinterventional radiologydepartments. Some interventionalradiology services arecommissioned via nationalspecialist commissioning.
4. Networks – Networking willbe essential to improve access tointerventional radiology. Thereare challenges in developingeffective operational deliverynetworks, primarily due to theshortfall in the recruitment ofconsultant interventionalradiologists.
20 Recommendations
The following recommendationsneed to be considered againstthe background of the NHSEngland, Seven Days a WeekForum.
Recommendations
Improving interventional radiology services should bepart of a whole pathway approach, including patientsand carers, referring clinicians (e.g. obstetricians for post-partum haemorrhage) and other key stakeholders
Ensure there is wider engagement between StrategicClinical Networks and the commissioning community andinterventional radiology service providers, to furtherdevelop appropriate network solutions to delivering safeinterventional radiology services, seven days a week
Ensure that the clinical standards relating tointerventional radiology within the NHS Services, SevenDays a Week Forum Findings are implemented
Consider commissioning a quality and cost benefitsanalysis of interventional radiology procedures versusconservative management or treatment
RECOMMENDATIONS
Appendix A 21
The Department of Health recently published two important documents which highlighted the need forpatients to have improved access to interventional radiology (IR) servicesi ii. The evidence base is cited in thetwo publications. The key drivers behind this work are:
• improvement in patient outcomes• reduction in harm to patients who cannot access the appropriate procedure in a timely manner.
The following are scenarios which should no longer occur. Organisations should ensure that processes are inplace to protect patients from harm in these situations and should report and investigate all such events.
Failure to be able to provide these services should be appropriately identified on Trust’s risk registers. Such IRprocedures need to be carried out with appropriate suppoort from multidisciplinary radiographic/nursingsupport so that timelines for these interventions can be met:
• High risk pregnancies should be delivered in hospitals with IR services who should be involved in the pre delivery planning.
• No patient should undergo laparotomy for lower gastro intestinal (GI) bleeding from any cause where embolisation may be appropriate without a referral to interventional radiology.
• No patient should undergo surgery for non-variceal upper GI bleeding without first undergoing endoscopic treatment, and if this fails or is inappropriate, interventional radiology.
• No patient with sepsis secondary to obstructed kidneys should wait longer than three hours for a drainage procedure such as nephrostomy.
• No severely injured patient should die of haemorrhage from pelvic trauma because of a lack of early imagingand referral for interventional radiology.
• No patient with a traumatic aortic dessection should have open surgery without a referral to interventional radiology for consideration of endovascular repair.
• No patient should have open surgical repair of a GI variceal haemorrhage which is refractory to all other treatments without a referral to interventional radiology for transjugular intrahepatic portosystemic shunting (TIPS).
• `no patient with symptomatic fibroids should undergo hysterectomy without being informed about all possible options including Uterine Artery Embolisation.
Adverse events avoided by the use ofinterventional radiology
Appendix A:
BSIR/NHS Improving Quality Adverse Events
i Interventional Radiology: Improving Outcomes and Quality for Patients (2009) Gatway Reference: 12788www.dh.gov.uk/en/Publicationsandstatistics/Publications/PublicationsPolicyAndGuidance/DH_109130
ii Interventional Radiology: A guide to service delivery (2010) Gateway Reference 15003www.bsir.org/Images/_Members/_administrator/File/ir_roadmap_dh_121906.pdf
24 References
1. NHS England (December 2013), NHS Services, Seven Days a Week Forum – Summary of Initial Findings
2. NHS England (2013), Everyone Counts: Planning for patients 2014/15 to 2018/19
3. NHS Improvement (2012), Towards Best Practice in Interventional Radiology
4. British Society of Interventional Radiology, BSIR Quality Initiative www.bsir-qi.org/apply
References
Contacts 25
To find out more about InterventionalRadiology at NHS Improving Quality please contact the following:
Fiona Thow, Programme Director,Interventional Radiology, NHS Improving QualityEmail: [email protected]
Peter Gray, National Improvement Lead,NHS Improving QualityEmail: [email protected]
Amy Hodgkinson, National ImprovementLead, NHS Improving QualityEmail: [email protected]
Carol Marley, National ImprovementLead, NHS Improving QualityEmail: [email protected]
Carole Smee, National Improvement Lead,NHS Improving QualityEmail: [email protected]
Ian Snelling, Senior Analyst, NHS Improving QualityEmail: [email protected]
Contacts
26 Glossary
Angioplasty - Technique to widen narrowed or obstructedarteries
Angiography - Imaging technique used to visualize theinside of blood vessels and organs of the body
Core Interventional Radiology Service - A set ofprocedures defined for the purpose of the national survey.These procedures should be able to be provided by allInterventional Radiology Services and include Embolization;Nephrostomy and endovascular intervention
CT - Computed Tomography - Technology that usescomputer-processed X-rays to make it possible to see threedimensional images of the body for diagnosis andtherapeutic interventions
D&C balloon - Also known as a ‘Bakri Balloon’ and is madeof silicone and specifically designed for the temporarytreatment of post -partum haemorrhage
Embolisation - Selective occlusion of a blood vessel
EVAR- Endovascular aneurysm repair - The repair of aruptured vessel which can be performed by open surgery orinsertion of a stent graft (fabric covered tube) into thevessel
FEVAR - Fenestrated endovascular aneurysm repair -Aneurysm repair that uses a device with fenestrations orholes that will accommodate arterial branches such as renalarteries
Hemi-colectomy - Operation to remove part of the largebowel
Interventional Endoscopy - Techniques involving a tubewith camera (endoscope) to perform minimally invasivediagnostic and treatment interventions
Interventional Radiology - A relatively new field ofmedical practice that uses imaging techniques to guideinterventional instruments into blood vessels and organs todiagnose and treat a wide range of clinical conditions
Nephrostomy - An artificial opening created between thekidney and the skin which allows urine to be diverted fromblocked kidneys
Glossary
Non-variceal upper GI bleeding-bleeding in the gastro - Intestinal tract that is not due to haemorrhageprone dilated blood vessels
Post-partum Haemorrhage - Bleeding in the pelvic area(often the uterus) following child birth
Renal dialysis access intervention - Insertion of cathetersor creation or repair of a renal fistula (a technique whichjoins an artery and a vein together to create a strong vesselto enable long term access for renal dialysis)
Ureteric stenting - A technique which involves insertion ofa stent/tube into the ureter (the tube between the kidneyand bladder which channels urine) to temporarily relieve ablockage
Specialist commissioning - Commissioning of specialistservices that are often high cost and/or low volume througha national rather than local commissioning approach
TACE (transarterial chemoembolisation) - A minimallyinvasive procedure performed by interventional radiologists to restrict a tumour's blood supply and insertchemotherapeutic agents into the arteries supplying thetumour
TEVAR - Thoracic endovascular aneurysm repair
TIPS - Transjugular intrahepatic portosystemic stentshunting is a technique which creates an artificial channelwithin the liver. It is used to treat liver cirrhosis whichfrequently leads to intestinal bleeding, life-threateningoesophageal bleeding and the build-up of fluid within theabdomen
Unbundled tariff - Identification of the price of servicessuch as radiology within the overall tariff
Uterine artery embolisation - A procedure where aninterventional radiologist uses a catheter to deliver smallparticles that block the blood supply to the uterine body.The procedure is done for the treatment of uterine fibroids
@NHSIQwww.nhsiq.nhs.uk
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