SIR Issues Guidelines on Staffing for Interventional Radiology Suites

May 5, 2016—The Society of Interventional Radiology (SIR) has published a position statement on staffing guidelines for the interventional radiology (IR) suite by Mark O. Baerlocher, MD, et al in the Journal of Vascular and Interventional Radiology (2016;27:618–622).

The document is intended to provide reference guidelines for the requirements for safe operation of IR suites in terms of appropriate staffing from patient intake to discharge (including pre-, peri-, and postprocedure requirements). In centers with a greater proportion of higher-complexity cases and/or patients at higher risk, there may be a need for additional staffing resources. The guidelines are based on the best available literature, including societal guidelines, as well as expert consensus, stated the authors.

According to the guidelines, staffing in the preprocedure and recovery rooms requires sufficient clerical, nursing, and ancillary staff. A clinical coordinator/scheduler should have a level of content expertise, including familiarity with IR procedure care and related patient issues, so that patients, families, and referring clinicians’ questions and procedure requests can be efficiently handled. 

For preprocedure and recovery rooms, the guidelines make the following recommendations:

• A general guideline of required nursing complement in the preprocedure/recovery areas is one nurse to three patients, in addition to the nursing staff complement required in the IR suites. 
• When a nurse-to-bed ratio has been determined, this number should be multiplied by a factor of 1.2–1.8 full-time employees per staff position to account for staff vacations, sick time, and educational leaves. 
• Staffing levels should ideally be optimized by incorporation of staffing needs into a continuous quality improvement program. 

For staffing in the IR suite, the recommendations are: 

• In addition to the IR physician, at least three nonphysician health care practitioners should be present per IR suite in use. In some complex patient procedures, four nonphysician health care providers may be needed. 
• Hospitals must be prepared to accommodate a sudden or unexpected increase in the number of IR cases scheduled for a given day. 

For off-hours (including on-call staffing), the recommendations are:

• A backup plan for situations in which the weekend or on-call/after-hours IR team is unavailable as a result of other urgent cases may be necessary. Personnel planning should be flexible to allow for an unexpected increase in urgent referrals. 
• Access to anesthesiology support should be available when necessary, based on the clinical judgment of the IR. Patients with an American Society of Anesthesiologist status of 3 or 4 will typically require an anesthesiology consultation.
• It is ideal to have at least three nonphysician personnel, at least one of which is a registered nurse, available for after-hours/on-call IR cases. In larger centers with a resident or fellow, only two nonphysician personnel, at least one of which is an registered nurse, may be sufficient for some on-call procedures. 
• Safety of the IR team, including the physicians, nurses, and technologists, must be taken into account when planning manpower resources. Adequate rest between cases or workdays is necessary.

Additionally, the guidelines advise that it is the unequivocal position of SIR that interventional radiologists should be provided with admitting privileges and have parity with other admitting physicians. Equally, longitudinal IR care requires dedicated clinic space, typically separate from the inpatient area, and resources for outpatient evaluation, examination, consultation, and charting.