The Reading Room

What MedStar Georgetown wants you to know about interventional radiology

by Erin Lane

This is part of a weekly series on conversations we had with interventional radiology (IR) leaders who represent programs in a variety of settings, including health systems, children’s hospitals, AMCs, cancer centers, and more. Make sure you’re subscribed to follow along.

For the first post in this series, we sat down with Dr. James Spies, MedStar Georgetown’s Chairman and Chief of Service for the Department of Radiology, to discuss his experience as an interventional radiologist and IR leader.

Overview of MedStar Georgetown's IR program

Setting: Academic medical center and teaching hospital in large, urban health system

  • IR program type: Mature research-based IR program
  • Program oversight: Department of Radiology
  • Physician staffing: Faculty IR group with 9 interventional radiologists
  • Dedicated IR space: The IR group owns an outpatient clinic, used for patient visits pre- and post-procedure. The IR program has 5 dedicated procedure rooms at MedStar Georgetown: 4 angiographic suites and 1 ultrasound procedure room.

Employed staff: 2 nurse practitioners (NPs) employed by the IR group; 8 registered nurses (RNs) employed by the hospital; 12 technologists employed by the hospital

  • Role of NPs: In the clinic, an NP prepares patients for visits by completing patient intake and medical history. In the hospital, an NP rounds with IR physicians, fellows, and residents for follow-up. They also round on chronic patients, usually those with long-term drainage catheters, and provide instruction for tube care post-discharge.
  • Role of RNs: During procedures an RN cares for patients including sedation monitoring. Outside of suite, an RN responsible for managing the IR procedure schedule.
  • Role of techs: During procedures techs handle imaging equipment and assist the physician. Techs are on call 24/7

IR suite staffing: Each IR procedure requires at least 3 individuals:

  • 1 interventional radiologist to perform the procedure
  • 1 nurse to care for patient and monitor sedation
  • 1-2 technologists depending on difficulty, with 1 tech using imaging equipment and 1 assisting the physician
  • Residents and fellows may also be in the procedure room. Depending on skill, residents may assist or perform procedures, while fellows observe

Typical daily volumes: 5-6 procedures per day per suite
Average procedure duration: 1-3 hours depending on complexity
Call coverage: 24/7 at two acute care hospitals
Top opportunities for growth: Ambulatory procedures, new research areas

Dr. Spies’ take on the value of interventional radiology

Q: To start our conversation fairly general, in your opinion, what is the value of interventional radiology?

Dr. Spies: Interventional radiology plays an essential role in delivering high-quality, cost-effective care for patients, both in those on the IR service and others in the hospital. IR helps facilitate basic care for patients, such as venous access, and serves in various ways almost all specialties, including oncology, gastroenterology, gynecology, and urology.

Although some roles may be small, IR allows the hospital and other physicians to provide high-quality patient care. In many cases, IR offers an alternative to surgery with faster recovery time, lower complication rate, and lower infection rate compared with more invasive procedures.

Q: We frequently hear from our members that although we know IR is valuable, demonstrating that value to the health system can be challenging. It sounds like at Georgetown, IR has become an essential component to patient care. How did you become such a valuable part of your health system?

Dr. Spies: We gained the trust of our health system by consistently adapting our services to meet new clinical needs and adjusting our schedule to accommodate emergency cases, while also delivering timely care for scheduled procedures.

Other programs can similarly demonstrate IR’s value through flexible scheduling. Unlike traditional ORs, our IR suites are not scheduled in blocks or reserved for certain physicians. The schedule is primarily managed by a nurse, referred to as the “board runner,” with assistance from a tech and physician. Our ability to accommodate both emergency and scheduled cases with ease is a major factor driving our growth and success.

Q: What are the biggest areas of growth or decline you anticipate seeing in IR over the next few years?

Dr. Spies: The scope of interventional radiology will continue to grow and evolve with the application of our skills and tools in new and creative ways. IR simply means minimally-invasive image-guided procedures.

As technology and medical knowledge continue to advance, physicians and researchers will continue to develop new IR procedures. This means that IR has huge growth potential, even for organizations with mature programs.

But growth may translate to physician conflict and turf battles have occurred; IR and other specialties need to ensure that patients received safe care. At Georgetown for example, our interventional radiologists were the first to offer endovascular services, and this significantly diminished surgical procedures for vascular disease. This led to competition between IR and vascular surgery for the same patient volumes, as the surgeons sought to retain their practices by co-opting these minimally-invasive techniques.

To navigate the conflict, interventional radiologists assisted vascular surgeons to safely perform endovascular procedures, which allowed vascular surgeons to retain their practice and allowed the IRs to help improve patient outcomes. There are always new areas IR can grow, so pulling away from endovascular allowed our physicians the opportunity to focus on new, cutting edge research areas.

Q: You bring up a great advantage of being a research-based IR program, which is you always have the opportunity to grow and offer new services. But with constant growth and new service offerings comes another challenge, which is physician education. How do you educate and inform your referring providers as to what services your program offers?

Dr. Spies: We leverage our research to educate providers and secure referrals. Educating referring providers is a challenge all programs face. At Georgetown, interventional radiologists offer research lectures to local specialty groups, leading to referrals from progressive specialists. Our group focuses on providing high-quality patient service and responsible care, which encourages more physicians to refer their patients to our program.

As our physicians continue to build a broad resume of publications, our colleagues see us as experts in the field and feel more comfortable referring patients to IR. We also take advantage of MedStar’s local physician newsletters and other communication tools to highlight recent publications and areas of research.

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