London Hospital’s Positive 25-year Experience Offering day-case IR Service

London, UK (2 August 2023) — Authors from King’s College Hospital (London, UK) have recently published a letter in Clinical Radiology detailing their centre’s experience after 25 years of day-case interventional radiology (IR) services. The King’s experience, according to the title of the response letter, has been “worth the effort”, which corresponding author Nuran Seneviratne et al explain is because day-case IR at King’s has proven to be “efficient, [to reduce] patient anxiety, [optimize] the role of the interventional radiologists in elective and emergency preassessment, [maintain] patient safety” and to pave the way for treating a “broader selection of patients” through a wider variety of procedures. 

Seneviratne and colleagues responded to a paper published earlier in 2023, also in Clinical Radiology, by Lakshminarayan et al, which makes the case for providing IR care in a day-case setup. Their reasoning for advocating for this model is, as outlined in the paper’s introduction, that IR has, over time, become less invasive, which “[enables] rapid recovery, [expediting] ambulation and [promoting] same-day discharge”. This model, Lakshminarayan et al detail, can improve patient experience and cost-effectiveness. 

The authors of the King’s letter outline that they wish to “offer encouragement” to other hospitals motivated to establish or improve their day-case unit to profit from the advantages it can offer, as set out in Lakshminarayan’s paper. At King’s College Hospital, theirs is a “dedicated 10-bedded, nurse-led day-case interventional unit”, the letter conveys. It “initially focused on peripheral angiography, vascular access, liver biopsy, and percutaneous drainage work, [but] the service has now expanded to encompass a broad range of arterial and venous interventions, a large hepatobiliary service, and interventional oncology procedures”. The authors add that since its foundation in 1997, the unit has carried out over 2,500 percutaneous liver biopsies. 

The letter goes on to include details of the vascular procedure data the unit gathered to assess the value of the unit. “The number of procedures increased steadily over time, and the proportion of interventional to purely diagnostic angiography also increased. There were also significant cost benefits compared to admission (£131.15 versus £318.65 in 2007). The complication rate was well within the accepted Royal College of Radiologists’ standards at the time, with only 5.2% of cases requiring admission due to complications.” 

Seneviratne and colleagues proceed to acknowledge that IR procedures are increasingly complex, and that, therefore, the day cases “now [require] more extensive input from interventional radiologists to ensure optimal patient selection, clinical optimization, and effective co-ordination 

with other specialties”. As was the setup back in 1997, the authors state that “the nurse-led model for the organization of the day-case unit, with pre-assessment conducted within the unit” today enables consultant interventional radiologists to work as efficiently as possible. 

The authors conclude their letter by sharing how their hospital is “poised to move into the next phase of day-case radiological intervention”, celebrating Lakshminarayan et al’s paper once again as “a timely reminder of the potential of IR”. Speaking to Interventional News, the King’s authors set out the next steps for their IR service. “We are further developing the clinical nurse specialist role to provide enhanced specialized care and support from our nursing staff, advocating for the patients’ needs, and coordinating care across the domains involved in the patient pathway. We are endeavoring to make the whole procedure experience for the patient ‘holistic’ with ‘fluid’ movement between the physicians and surgeons caring for the patient, with the radiologists pivotal to the care management strategy. 

“We are also developing an anesthetic pre-assessment system, guided by anesthetists, focusing on comprehensive evaluations, prioritizing patient safety during and after day case procedures. In addition, we will expand the modalities for pre-assessment system as our institution covers a large catchment area, with patients often having to travel far for our services. This includes ensuring in-person reviews are necessary and considering alternatives such as video calls and mobile assessment units. Better access to clinical information, including blood tests, from services closer to the patient will help reduce unnecessary patient journeys and improve their experience. With regards to technique, improved usage of variation in the vascular access route e.g. radial artery access in certain procedures, is being expanded to improve patient ambulation post-procedure and shorten recovery times.  

“Through these initiatives, we aim to advance patient care, optimize outcomes, and strengthen our institution’s commitment to excellence.”