Title : Interventional radiology and anesthesiology: Collaborative approaches to quality patient care
The cooperative approach between physicians during cancer patients treatment is actually a medical cornerstone. New developments centered on interventional radiology have transformed the oncological outcome of not candidate surgical patients. As proposed by Executive Council of the Society of Interventional Radiology (SIR) the interventional radiology (IR) offers the better, safer,faster and less expensive options in many clinical scenario. The IR guarantees its role in the patient centered health care system through the use of standardize procedures, the use of data to improve continuous the quality of care and the cooperation among all members involved into procedural technique from oncologists to anesthetists. The implementation of standard care is not an innovative concept but nowadays the physicians and health care system measure only what they directly manage rather than the outcome. Therefore is mandatory to analyze during all IR procedure the health status achieved or retained, the process of recovery and, regarding economical aspect, the sustainability of health. This process is achieved not only by radiologist but also by other physicians in particular the anesthetist outside its common territory , the operating room (OR).Pomerantz P.defined thenon operating room anesthesia (NORA) “Away from the OR and closer to the patient”. This definition reveals the patient centrality and erases the myth that the surgical procedures on sick patient have to performed only into operating room. Therefore many national society of anesthesia have developed their recommendations for anesthesia and sedation in nonoperating room locations underlining the importance to perform a preoperative assessment (a complete visit focusing on requested haematic exams, electrocardiogram, chest x-ray) to guide the intraoperative anaethesiological plan and to achieve an optimal recovery status. In literature several manuscripts debate about adequate physician skills for outfield interventional radiology procedures and all articles emphasize that all anesthesist providers have to consider the possibility to shift from a “simple- weak sedation” to a “complete general anesthesia”. The use of sedative combinations (antinociceptive, hypnotic and amnestic component) produce variable consequences in vulnerable patients. Therefore is necessary to implement all type of cooperation between staff involved guarantying the adequate airway and circulation support. The practical aspects of the clinical scenario have to maintain the same level of safety and standardization of operating room through infrastructure check, scheduling rules and procedure plan shared, careful monitoring according to standard practice and post procedural evaluation. Nowadays the non operating room procedure complications are an important portion of total claims and the payments are greater likely in operating room claims therefore the anaesthesia care is directed to implement the standard of NORA to reduce the adverse event.
- The importance to proceed during interventional radiology procedures according to standardize protocols is necessary not only for radiologists but also for all physician involved in patient care in particular the anesthetist. -
- All patients have to manage as into operating room setting.Therefore all quality standard of operating room is necessary before to start all procedure.
- Further research is to consider to implement the security of interventional radiology focusing on reduction of adverse events.