VIR Case Level Classification System

Add-on cases will be classified according to their urgency level to facilitate the triage and timely care of urgent/emergent cases.

• Case urgency level timing standards and associated diagnoses are guidelines and are not intended to be absolute.

• The attending interventional radiologist will make the final decision regarding the urgency level based on their clinical judgment.

• The Charge Team (RN-C and AN-C) will make the final decision regarding the case/team to be bumped to accommodate an urgent/emergent case based on their judgment and the OR/IR dynamic capacity.

Case Levels

All case postings with anesthesia require a case classification level and additional level-specific information (attending availability) to facilitate triage and scheduling. In the absence of a classification level on the posting, all inpatients will be designated level E.

o   1: Emergent (<60 minutes)

§  Immediately Life/limb-threatening

§  Waive H&P

§  Waive consent

§  Board runner speaks with RN-C directly regarding patients' needs and plan

§  Patient is transported directly to IR without stopping at a bed first

§  Cases include trauma patients, Ob post-partum hemorrhage patients, hypotensive patients requiring transfusion, septic shock patients

o   2: Urgent (<3 hours)

§  Waive H&P

§  Risk of harm from delay over-rides risk of non-fasted state

§  Board runner speaks with RN-C directly regarding patients' needs and plan

§  Board runner sends for the patient immediately

§  Cases include active extravasation that does not meet the above criteria, septic patients that do not meet the criteria above

o   3: Today (<9 pm)

§  Add to the end of schedule today (will not bump a scheduled case. <9 pm if posted by noon

§  Resident posts estimated time patient medically ready

§  RN-C proactively boards to snapboard

§  Cases include (but are not limited to) pseudoaneurysm, unstable thrombus, percutaneous nephrostomy tube placement, and percutaneous biliary drain placement at the discretion of the attending interventional radiologist

o   4: Next Day (<5 pm next day)

§  Place on the next day’s schedule (will not bump a scheduled case)

§  Resident posts estimated time patient medically ready and attending available

§  RN-C/Scheduler proactively boards to Snapboard

§  Cases include stable inpatients, all other cases not meeting the criteria above