Pre-assessment – how we do it: Manchester foundation trust

Created - 01.09.2022

Across the country the pandemic has ushered in a significant change in practice and delivery of clinical care in the NHS. Interventional radiology services were by no means immune to these changes. The persistent, relentless restrictions and chaos imposed by the COVID pandemic has allowed us to revaluate, rethink, and reinvent how we deliver this service in the most efficient way possible.

One of the significant changes we have implemented was the overhaul of IR and consent clinics. Like most, we implemented IR clinics early in the 21st century, but the clinics were ad-hoc and filled with patients scheduled for complex or uncommon procedures which needed significant IR input. Most of the procedures were performed with the understanding that the referring clinicians would explain the procedure to the patients, and we would in-effect confirm the procedure in the IR holding area and proceed. Whilst this may have been an acceptable practice for a diagnostic procedure, this was wholly inadequate for most current therapeutic procedures, which could have a life changing consequence or impact. In the current day, most centres have ceased to be diagnostic hubs and have rapidly evolved, providing therapeutic care. Whilst our skill and service has dramatically expanded, offering an ever-increasing solution for most complex problems, our IR clinics and consent process failed to evolve at the same speed. We needed a change. We needed to review and readjust our patient care pathways from consent to cure.

This involved carefully selecting and training a Band 7 nurse, who would see our patients face to face or via a telephone consultation and go through our IR specific admissions pathway, determining the suitability of the patient for day/overnight admission. This pre-op also includes relevant blood tests and ECG if indicated. An IR consultant then sees the patients and consents the patients for the procedure, addressing any issues bought up during pre–OP, Providing the patient with excellent BSIR patient information leaflets tweaked with local details, wraps up our pre-op and consent process three days prior to the scheduled procedure.

Our in-patients are met on the wards by an enthusiastic COD, not to be mistaken for our “Piscean” vertebrate, but a “Consultant of the Day” who takes on the responsibility of seeing the in-patients and consenting them on the ward at least 24 hrs before the procedure. This allows the patients to be properly evaluated and consented prior to the IR procedure.

The key components that have made a difference to this successful system are a dedicated team of Band 6 nurses who have an understanding of the pre-op and peri-procedure details, administrative staff to book patients and a consultant of the day who is responsible for all queries related to IR, checking on call vascular reports, reporting urgent inpatient vascular scans and generally fielding clinical calls of the day. These duties were made visible and included in the rota.

Other resources that have helped address these issues include robust IT support to manage remote clinics, point of care test facilities for critical blood results like INR, and more recently, a complete integrated EPR system called EPIC.

Change is always difficult, often evoking sentiment of cemented outdated practice structures, which may have worked perfectly well in the past. After 2 years and over 1000 patients later, we look back at how our practice has changed. We live in an environment that is in a constant flux of both expectations and outcomes of medical treatment. It is this flux that needs to be understood and harnessed, so we as a speciality can adapt and deliver an evolutionary change. After experiencing initial inertia to change, if a sceptical species, like me, has learnt to accept and embrace this change as the future direction of IR, there is certainly hope for the rest.

Nirmal Kakani & Ananth Krishnan, Consultant Interventional Radiologists

Ruby Malik, Interventional Nurse MFT, Manchester