Optimizing Interventional Care at UMMC: A Case Study

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Jeff KnoxInterventional-radiology departments are facing increasing demands to justify costs, measure outcomes, and prove value in a competitive clinical environment. Though they are often managed alongside their diagnostic-radiology counterparts, the reality is that interventional-radiology departments have more in common with cardiac catheterization, electrophysiology laboratories or endoscopy than with diagnostic-radiology departments, according to Jeff Knox, MS, RT(R)(CV), CRA, director of operations and asset manager for the department of radiology at the University of Maryland Medical Center (UMMC), Baltimore.

Karen Finnegan“Diagnostic radiology is very transactional, by comparison,” Knox says. “Interventional radiology is much more patient centered. It’s a continuum experience: Some of the patients are seen in our outpatient clinic by a radiologist; the patients are always assessed pre-procedure by a nurse, physician’s assistant, nurse practitioner and/or a radiologist; post-procedural care and instructions are given; and some patients have follow-ups in our outpatient clinic.”

Fifteen years ago, the interventional-radiology department at UMMC implemented an informatics solution developed by the Society of Interventional Radiology and aimed at streamlining the complex processes inherent in handling a high volume of interventional procedures. The HI-IQ product, now distributed by ConexSys, enabled the department to manage its outpatient scheduling and inventory better.

When UMMC began using HI-IQ, the high cost of interventional supplies was an easy target for hospital administrators with their eyes on the bottom line. Karen Finnegan, MS, RT(R)(CV), chief technologist for interventional radiology at UMMC, says, “As the field developed from diagnostic to interventional, our inventory was becoming more expensive. We had to do a reconciliation process every six months, and to do that on paper was very tedious.”

She continues, “In the beginning, we used HI-IQ to automate that process, so everyone would know what we had on hand, in terms of products.” Today, further integration has made efficiencies in billing and ordering possible. Finnegan says, “The list of inventory produced by the system goes downstream to billing, so the product comes out of inventory, generates a bill, and can go to automatic reordering.”

Unique Requirements

UMMC’s interventional department includes eight vascular radiologists, three neuroradiologists, 30 registered nurses, 16 radiologic technologists, four patient-care technologists, and three schedulers (one for inpatients and two for outpatients). The department handles 11,000 vascular procedures and 4,800 neurological procedures annually. “We’re the group that manages the patient completely—they’re referred to us for treatment, and we’ll manage them until that treatment is complete,” Finnegan notes.

That means longer patient encounters encompassing a broad array of clinical needs, Knox says. “I come from a cardiac background, and I was used to one organ and one set of tools you needed to have,” he observes. “I thought that was a lot—until I came to interventional radiology. I had no idea how big an inventory could be, or how extensive and expensive. It’s very complex.”

With this growth in the number of procedures performed, and the concurrent expansion in the clinical management of patients, the way that the interventional-radiology department aggregates and manages its data has also evolved. Knox explains that traditional information systems for hospitals and their radiology departments often fall short of meeting the needs of interventional radiology. For instance, because diagnostic radiology doesn’t include the inventory necessary for interventional procedures, the typical RIS is not built to track utilization easily.

“Like everyone in health care, we want to be cost effective,” Knox says. “HI-IQ gives us the tools to look at who is doing what, how long it’s taking, and which inventory items are used.” This information empowers the interventional department in its discussions with the hospital concerning budgets and planning. He says, “We can value our inventory at any time, and our staff scans in used inventory, which reduces the on-hand counts of the items.”

Patient Management and Satisfaction

Patient satisfaction is becoming increasingly critical to health-care providers, and managing patients can be a particularly challenging proposition in a complex department with many moving