How to work well in Interventional radiology unit : Experience of Konyang University Hospital, South Korea
Jeon Chang Min*
Eum Jin Hee**
Kim Ji Hyun, M.D.***
*chief radiographer , **nurse, ***chief interventionist
Department of radiology, division of intervention, Konyan University Hospital, Daejeon, South Korea
quested by เอนก สุวรรณบัณฑิต คณะแพทยศาสตร์ศิริราชพยาบาล ม.มหิดล
Jeon Chang Min, Eum Jin Hee, Kim Ji Hyun. How to work well in Interventional radiology unit : Experience of Konyang University Hospital, South Korea. วารสารชมรมรังสีเทคนิคและพยาบาลเฉพาะทางรังสีวิทยาหลอดเลือดและรังสีร่วมรักษาไทย, 2550; 1(2) : 17-21
Best practise of managing the patient in interventional radiology is important critique from the worldwide. One model, Konyang UNIV. hospital opened in February, 2000, with an ideology "Truth, Creation, and Service"
Konyang UNIV. Hospital has strived for being a leading hospital that protects the health of a community, and creates a new medical culture of 21st century.
Introducing the state-of-the-art medical equipment such as vision diagnosis system, clinical pathology automatic system, computerized prescription, etc., and securing superior medical staff, Konyang UNIV. Hospital will develop into a second to none hospital in the central Korea, which is equipped with 700 beds on the land of 23,000 pyong (unit of area in Korea) and building area of 13,000 pyong. With an image of a clean and kind hospital, additionally, we will contribute to improving national health and medical welfare of a community by providing a free clinic service for needy neighbours who can hardly receive the treatment due to an economic difficulty, and sharing the medical information with other hospitals.
Depatment of radiology, division of intervention, Konyang University Hospital comes to show the basis of managing all for the best care deliver to the patient from the IR colleages. How to work well is be explicit role for others to learn and adapt for those practises. Steps of working usually same as another IR suite however system thinking of procedure is more concerned. 11 steps for best work in IR are :
Basic available of IR colleages in division of intervention, department of radiology, Konyang University Hospital, There are 4 radiographers, 2 nurses, and 1 supplementary member.
1. How to be act on the routine procedures to prepare the IR suite?
For preparing the IR suite, radiographer has to:
1) Turning on angiography machine in the morning and calibrating fine functions such as three dimentional angio tool or angio-CT
2) Cleaning angiography machine and control console
3) Confirming today's schedule, calling nurses working in ward to ask about changes in schedule, whether appropriate premedication was done, whether permission paper was filled up by patient and /or families.
4) Checking devices that will be used in today's procedures.
2. How to act for patient identification?
1) In the ward, patients take the first identification process, ward nurse do it, and patients have a bracelet presenting their name, age, sex, and unit number on their wrist.
2) When patient reach IR unit, radiographer or nurse identify bracelet and directly ask name to the patient (except unconscious patients).
3. How to manage the urgency and emergency case?
1) The emergency cases are directly notified to interventionalists (doctor) from resident or staff of emergency center. Emergency cases sometimes happen in theward patient, which are also directly notified to the IR doctor.
2) Just after notification, the patient is moved to IR unit Zwe have two angiography machines and two IR doctor) and IR procedure for diagnosis and/ or treatment is performed. However most of them arise in the night (PM 9:00 - AM 4:00), so we have 24 hour emergency IR system, emergency cases are first notified to radiology resident on duty and he/she calls and interventionalist on duty. when the resident calls, he/she also call the radiographer on night duty, who calls us (radiographers responsible for intervention). They can reach hosptial within 30 minutes to 1 hous after notification, the role of radiographers in emergency cases is basically same to day work. Preparing set for intervention, manage and control angiography machine, and scrub for the procedure.
4. How to prepare the patient informations and documents?
To get an information and document we need, we read patient's chart or call resident or staff who are responsible for the patient. Laboratoy findings and previous x-ray results can be identified on hospital computer network.
5. How to act for procedure planning (which vessels or embolisation will done)?
All things about procedure is decided by chief interventionalist (Dr.Kim), however, when clinical problem of the patient is complex and following surgical operation is needed, cheif interventionalist ususally discuss with surgeon or doctor in charge. When chief interventionalist is absent, all things are decided by Dr.Park, Junior staff of IR unit. If futher assessment for the patient's clinical condition is needed, we consult to doctors with specialty.
6. How to scan for the near missed that will be protect before start the case?
Of course we can meet patients whose history is unclear or not completely identified, especially for iodine allergy or cardio/ nephrologic diseases, that situation is relatively common in car accident patients without clear consciousmess. To be honest, there is no way to guarantee safety in them, skin test for contrast media can't completely exclude iodine allergy. The best way is to be careful of possiblility for dangerous situation that may be result in. We are closed connected to emergency center doctors and they can reach our IR suite within a few minutes when dangerous situations happen.
7. How to maintain the angiography machine and injector"
1) Cleaning everyday (machine, IR rooms)
2) Check its function daily if any problem is detected, notifiy to service center of machine vendor (Siemens, Philips, Medrad).
3) Fine tuning for the machine daily
4) Check temperature/ humidity control machine daily, especially just befor going home.
8. How to deal with communication problem?
Communication problem is rare between colleagues (IR doctors, radiographer, IR nurse) because all of us are working in limited space and talk every time. But it sometimes happens with anesthesiologists, referring doctors, and ward nurses. The problem is various but mostly about schedule and pre/post medication. When we realize problem for the schedule or management for the patient, we directly call the doctors, nurses, anesthesiologist to notice and resolve. Of course main role in solving communication problem is done by IR doctors. Calling to ward or anesthesia department is usually done by radiographers. Checking pre/post medication in ward is done by IR nurse.
9. How to maintain skill of radiographer?
Korean IR radiographers have their own association and also attend Korean Interventional radiology meeting with doctors and nurses. And local IR radiographers' meeting is regularly hold, in which they exchange informations and learn new techniques or procedures. For public relation, department of medical insurance in our hospital helps radiographer to take informations and do other activities.
10. How nurse act for IR suite?
Because of we have only one nurse in the intervention unit. Her job is classified into 2 categories
- First, patient monitoring
- Second, administration of drugs
During procedure, especially in critical patients such as neurointervention cases, monitoring vital signs and neurological state is very important. Although intervetnionalists watch vital signs and examine neurologic state, the nurse helps it very intensively for interventionalists' convenience. As you know, drug administration is frequently needed in intervention cases. IV heparin, vasodilators, antiemetics, pain killers, and sedatives are included in the drugs frequently used in our unit during procedure. She has respinsibility to give those drug to the patient in adequate dose and appropriate route.
11. How to deal with mamagerial function?
Cheif interventionalist as the director of radiology department helping radiographers to do the job, and know well about hospital or other IR ralated management. Human relation is included in hospital education. All workers of our hospital take well organized education for human relation offered by hospital.
As 11 steps done, people in IR unit can fit in system thinking explicitly and be role model for another IR suite. However learning the way to find out the routine problem and prevent it, will more drive the better care delivery to the patient for the future.