Appendix 6 1 Emergency Radiological Interventions 6

Transcription

1 Non vascular Standard Operating Procedure to Request Out of Hours Classification: SOP Lead Author: Dr. J Carlin, Consultant Radiologist Additional author(s): Jonathon Priestley, Radiology Business Manager Authors Division: Clinical Support Services and Tertiary Medicine Unique ID: TWCRad01(16) Issue number: 2 Expiry Date: January 2021 Contents Section Page Who should read this document 2 Key points 2 Policy/Procedure/Guideline 3 Explanation of terms/ Definitions 4 References and Supporting Documents 4 Roles and Responsibilities 4 Appendix 6 1 Emergency s 6 Document control information (Published as separate document) 7 Document Control 7 Policy Implementation Plan 8 Monitoring and Review 8 Endorsement 8 Equality analysis 9, 10 Page 1 of 6

2 Who should read this document? All staff involved in the referral or acceptance of radiology interventional procedures outside of standard working hours: Consultant Radiologists at SRFT Consultant Interventional Radiologists at Manchester Foundation Trust (MFT) Referring Clinical Teams Key Messages This procedure has been devised to avoid potentially dangerous delays in provision of timely radiological intervention. Background 1) Skills to perform radiological intervention are not uniformly distributed across the SRFT Radiologists and SRFT, as is common across the UK, has encountered situations whereby a patient deserves radiological intervention but access to that intervention has been delayed and patients have encountered subsequent complications or poor outcomes as a result. 2) A diagnostic Radiologist may identify findings that might benefit from radiological intervention but be unable to provide this intervention themselves. In these cases, it is their role to explore the availability of interventional colleagues at SRFT or MFT. 3) Radiologists with intervention skills who are not on call have no contractual obligation to be available and contactable and they do not have an individual or collective contractual obligation to provide intervention out of hours. 4) The current difficulties with provision of a non-vascular intervention rota out of hours introduces risk. These risks are recognised in a radiology risk register which currently scores a 11 (October 2016). 5) Timing of radiological intervention should generally be guided by the severity of the of acute illness and the patient s general condition, in accordance with the scale outlined in the Royal College of Surgeons, Care of the acutely unwell general surgical patient. The Higher Risk General Surgical Patient : Towards Improved Care for a Forgotten Group. 6) It is accepted that the vast majority of non-vascular interventional cases presenting out of hours can wait until the next daytime/normal working session. In the RCR document entitled Provision of Interventional Radiology Services, it is recommended that access to intervention for nonvascular cases involving genito-urinary or gastro-intestinal presentations are provided within 12 hours and 24 hours respectively. Page 2 of 6

3 7) MFT will have an emergency non-vascular intervention service on Saturdays and Sundays. There is an agreement that any intervention cases that cannot be safely performed at the weekend at SRFT can be discussed with the non-vascular interventional Radiologist (NVIR) at MFT. If deemed appropriate by the NVIR then the patient must be referred through the relevant clinical teams for transfer to MFT. Policy/ Guideline/ Protocol Any requests for intervention which can be delayed until normal working hours should not be discussed after 23:00 or before 07:00 as this is unlikely to facilitate earlier intervention. In the event of non-vascular radiological intervention being required out of hours the following steps should be taken: 1) Diagnostic imaging occurs, with findings suggesting that intervention may be appropriate 2) Findings are flagged to the clinical team. 3) If a trained NVIR is on call, the clinical team should discuss the case with the Radiologist on call and the intervention performed as agreed by both parties. 4) If a diagnostic Radiologist is on call, the clinical team should discuss the case with him/her on call and request that the Radiologist establishes availability of an trained interventional colleague. A list of which SRFT Radiologists can undertake the commonly requested out of hours interventions can be found in Appendix 1. 5) The diagnostic Radiologist who will not have seen, assessed or examined the patient is not in a position to establish if or when an intervention might be appropriate. Their role is confined only to establish a colleague s availability to explore the possible need for intervention. 6) The diagnostic Radiologist should attempt to contact an appropriate name from the list in Appendix 1. If successful, the diagnostic Radiologist should inform the clinical team to contact the SRFT NVIR as identified. 7) If an intervention is required at the weekend and no SRFT NVIR is available then the SRFT diagnostic radiologist should call the MFT diagnostic radiologist who will contact the NVIR at MFT to review the case. The MFT NVIR will then make a recommendation to proceed with an intervention to the SRFT diagnostic Radiologist if this is deemed appropriate. 8) The SRFT diagnostic Radiologist informs the clinical team to contact the MFT NVIR as identified. 9) A senior clinician, in almost all cases the Consultant Surgeon, calls the nominated NVIR who will be expecting the call and will discuss: a) The clinical aspects of the case and the level of need for intervention b) The relevant imaging c) The clinically appropriate timescale Page 3 of 6

4 d) The balance of risks introduced by performing the procedure in an out of hours setting without normal level and skills of staffing support 10) If the case is accepted by a MFT NVIR then the referring surgeon must make contact with the appropriate clinical team at MFT to arrange patient transfer. 11) The clinical team ensure that a detailed discussion occurs with the patient outlining the proposed procedure and appropriate consent is obtained. Safe management of the patient undergoing radiological intervention This SOP details only the method of approaching an NVIR. Safe care of the patient while travelling to, in the radiology department and following a procedure must be considered and addressed separately by the clinical team. This may include appropriate nursing and medical support for patient transfer. If appropriate medical and/or nursing support cannot be provided then the NVIR may not be able to perform the procedure. Explanation of terms & Definitions HB Hugh Burnett (Consultant GI Radiologist) LW Luke Williams (Consultant GI Radiologist) DK Dina Kasir (Consultant GI/Gynae Radiologist) SG Sunethra Ghattameneni (Consultant GI Radiologist) AW Anna Walsham (Consultant Chest Radiologist) FH Fran Hampson (Consultant Chest Radiologist) AC Alistair Cowie (Consultant Uro-Radiologist) SS Syahminan Suut (Consultant Uro-Radiologist) FH Frances Hampson (Consultant Chest Radiologist) IR Interventional Radiology NVIR Non-Vascular Interventional Radiologist PTC Percutaneous Transhepatic Cholangiogram CMFT Central Manchester NHS Foundation Trust SRFT Salford Royal NHS Foundation Trust Roles and responsibilities Clinical Director and Radiology Business Manager/Deputy Radiology Manager Implementation and communication of this SOP to clinical teams and across radiology Directorate. Consultant Radiologists Facilitate provision of radiological intervention at SRFT when required out of hours. Page 4 of 6

5 Consultant Interventional Radiologists at MFT Facilitate provision of radiological intervention at MFT when required at weekends Referring Clinical Teams To ensure that only relevant radiological interventions are requested out of hours. To ensure that interventions requested are urgent and cannot wait until the next available session during normal working hours. To be responsible for referral through the appropriate clinical teams for transfer to MFT in the event that intervention cannot be provided by radiology at SRFT. Any requests for intervention which can be delayed until normal working hours should not be discussed after 23:00 or before 07:00 as this is unlikely to facilitate earlier intervention. Page 5 of 6

6 Appendices Appendix 1 Emergency s: Not all interventions can be performed by all interventionalists. The following list aims to describe individual competencies as opposed to availability of intervention. i) Nephrostomy: HB LW AC SS ii) Gall Bladder: iii) PTC: iv) Colon stent: DK SG HB LW HB LW HB LW v) Liver drainage: DK SG HB LW vi) Abdominal abscess Drainage vii) Trans-gluteal abscess drainage viii)peritoneal drainage: DK SG HB LW AC AW SS FH HB LW AW DK SG HB LW AC SS FH ix) Chest drainage for empyema AW DK SG HB LW AC SS FH (Respiratory team should be contacted in first instance) x) Naso-gastric tube insertion HB LW DK (Upper GI Surgery Cases only) Page 6 of 6