SHM Converge Scientific Abstract ePoster Gallery-Assessing a Hospital Medicine Procedure Service's Reliance on Interventional Radiology

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This process improvement project evaluated how often a high-volume hospital medicine procedure service (MPS) needed help from Interventional Radiology (IR) for bedside procedures, including central venous lines, lumbar punctures, paracenteses, and thoracenteses. The goal was to reduce unnecessary IR use, improve IR throughput, and clarify escalation pathways.<br /><br />The MPS and IR teams created a standardized workflow in August 2024 that positioned MPS as the first-line service, defined clear communication and escalation steps, and tracked IR involvement using a structured Epic SmartList. Data were continuously monitored through Epic and PowerBI, with minor process adjustments made as needed.<br /><br />Results showed very low reliance on IR. From August 1 to October 31, 2024, 748 consults were completed, and 98.4% were managed by MPS without IR involvement. Updated data through March 29, 2025 showed 2,076 total consults, with 98.2% handled by MPS, 1.2% requiring IR for technical reasons, 0.2% involving direct bedside collaboration with IR, and 0.4% outside MPS scope.<br /><br />The authors concluded that at this institution, escalation to IR was negligible despite high procedural volume. This suggests that a well-established MPS can manage most procedures independently when supported by a clear escalation process. The findings may be especially useful for internal medicine proceduralists, practice leaders, and hospital administrators considering the value and structure of an MPS.

Asset Subtitle

Christopher J. King

Meta Tag

Author List Carolina Ortiz Lopez, Christopher J. King, Henry R. Kramer

Category Innovations

Concept Hospital Medicine Procedure Service

Concept Procedure Request Management

Concept Escalation Process

Concept Interventional Radiology

Concept Process Improvement

Distinguished Non-Finalist

Presenter Organization University of Colorado, Division of Hospital Medicine

Presenting Author Christopher J. King

Track Quality Improvement

Keywords

process improvement

hospital medicine

interventional radiology

bedside procedures

central venous lines

lumbar puncture

paracentesis

thoracentesis

workflow standardization

escalation pathways

Hospital Medicine Procedure Service

Procedure Request Management

Escalation Process

Interventional Radiology

Process Improvement