Wanchun Connie  Lu, DNP, AC-NP, CNS

Abstract:

Background: Procedure cancellations in outpatient interventional radiology (IR) can lead to delays in diagnosis, lost revenue and underutilization of department resources. Current practice at some centers is the use of registered nurses (RN) to conduct outpatient pre-procedure telephone screening. However, same-day procedure deviations requiring cancellations remains high. This quality improvement (QI) project evaluated the effectiveness of an advanced practice registered nurse (APRN) driven pre-procedure clinic to assess same-day cancellations, days to procedure, and cost-effectiveness compared to RN telephone screening for biopsies. Objectives: To determine if an APRN interventional radiology pre-procedure clinic will reduce cancellation rates, days to procedure, and lost revenue in comparison to nurse telephone screening for outpatient biopsies. Methods: Using a comparative design, 111 patients (47 APRN pre-procedure clinic group and 64 historical RN telephone group) were examined via retrospective medical record reviews between August 1, 2019 to January 1, 2020 [RN group] and August 1, 2020 to January 1, 2021 [APRN group]. Patient information extracted were demographics, insurance type, anesthesia classification, biopsy type, cancellation and reason, and days to procedure referral. Estimated lost revenue was calculated based on procedures cancelled and summed per group based on procedure reimbursement, facility and clinic fees, and professional fees [physician, RN or APRN]. Descriptive and inferential statistics were used to assess group differences. Results: There were no statistically significant differences between patient groups for demographics and clinical conditions (similar types of biopsy procedures). The most common reasons for cancellation in both groups were patient factors, including elevated blood pressure and acute illnesses. There were significantly more cancellations in the RN group (18/28%) in comparison to the APRN group (9/14%; p=0.018). Additionally, the RN group had greater numbers of days to procedure (36.2 ± 21 vs. 21.3 ± 18, mean ± SD, p <0.001), and lost revenue ($160,956 vs. $82,818, p <0.001) compared to the APRN group. This reflects an institutional cost savings of almost $80,000 (50%) over the 5-month period of this project. Conclusion: Our findings show that an APRN pre-procedure clinic is effective in reducing same-day procedure cancellation, days to procedure (expediting diagnosis and treatment), and is cost-effective to the institution. Future QI is warranted to confirm these findings and to examine the potential impact of the expansion APRN pre-procedure clinic to include all IR procedures. 

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