Pre-visit factors affecting the duration of IR procedure visits

Despite the relatively low-risk and routine nature of interventional radiology procedures, procedure-visit duration is variable, complicating room utilization and staffing. The purpose of the study was to assess the impact of pre-visit choices on the duration of pre-procedure, intra-procedure, post-procedure, and total visit duration for patients undergoing interventional radiology procedures. 

Materials and Methods:

At a single institution, between June 6 and July 20, 2022, nurses recorded relevant visit timestamps using a combination of handwritten forms and the Hi-IQ scheduling software. Variables including inpatient versus outpatient, completed pre-arrival consent (routinely obtained for patients that had a prior office visit), the need to obtain same-day bloodwork, the type of pain management, procedure type, and operator type (physician assistant (PA) versus resident) were extracted from each case’s electronic medical record. Times were analyzed by way of linear mixed models.

Results:

Completed time durations were collected for 498 visits. For all visits, preparation time averaged 80.7 minutes (SD=52.6), procedure time averaged 77.2 minutes (SD=52.8) and recovery time averaged 42.7 minutes (SD=59.3). 

For preparation time, outpatient status (+46 minutes [95% CI: 37.9, 54.2], p< 0.001), completed pre-arrival consent (-34 minutes [95% CI: 23.8, 44.3], p< 0.001) and the use of anesthesia (+24 minutes [95% CI: 10.11, 38.7], p< 0.001) made a significant difference, while the need for bloodwork did not (p=0.955).  

For procedure time, the use of anesthesia (24.4 minutes [95%CI: 10.11, 38.68], p< 0.001), sedation compared to only local anesthetic (+37 minutes [95% CI: 28.9, 45.0], p< 0.001) and the type of procedure (e.g. mean 20.0 minutes for a upper extremity venogram to 186.3 minutes for a runoff with atherectomy or stent (p < 0.001)) were significant. For PICC and tunneled line placements, PAs provided a shorter procedure time than residents (PICC, -13.5 minutes [95% CI: -19.16, -7.91], p< 0.001; tunneled line placement, -11.31 minutes [95% CI: -19.1, -3.53], p=0.005) but no difference in total visit time (p=0.853 and p=0.857); they had similar procedure (p=0.365) and total visit times (p=0.885) for port placements. 

Conclusion:

Differences in the availability of a pre-procedure consent, the choice of pain management, procedure type, and the selective application of PAs significantly impact pre-procedure and procedure time. Among these variables, the completion of pre-procedure consent prior to patient arrival appears the most easily modifiable.