The evolution of interventional radiology (IR) is marked by numerous technical milestones. These include angioplasty, embolization therapy, and advanced image guidance. The latest innovation, however, is administrative in nature. The Ghent University Hospital in Belgium, has set up a stand-alone interventional radiology department. As such it reports reduced length of stay and increased patient satisfaction.
Photos: Christophe Vander Eecken
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“I hope I have shown them the way forward.”
Located in one of Belgium’s Dutchspeaking provinces, the Ghent University Hospital buildings are dispersed over a vast area of 42 hectares in the southern part of the city. Luc Defreyne, MD, PhD, Professor of Interventional Radiology and Head of the Vascular and Interventional Radiology Department (VINRAD), was previously dedicated to providing clinical treatment for other internal departments. He created an autonomous IR Department where patients receive high-quality, cost-effective care.
Building a clinical home for IR
Defreyne faced a number of challenges while setting up the department, but also notes that the change benefits the hospital and its patients: “Due to its size, the hospital is divided into eight departmental sectors to ensure better overall management. Unfortunately, the IR Department was caught between two sectors. Obviously we were part of the Supporting Departments sector, but as we cover a lot of critical-aid interventions for the intensive care unit and the emergency unit, we were also part of the Critical Services sector. As such, we were never considered an autonomous entity – more like a supplier of diagnostics for other doctors and departments. This meant we were financially dependent on these other sectors.”
Meeting the challenge
The push for independence developed gradually and due to various circumstances. “First, we needed dedicated staff. In IR, we treat patients from head to toe. We perform minimally invasive interventional therapies for a wide range of pathologies. These include vascular surgery, neurological interventions, interventional tumor treatment, and many critical interventions in cases such as upper gastrointestinal bleeding”, says Defreyne. “It was becoming harder to find nurses willing to work at night – often for many hours – during emergency interventions. Most were seeking a better work-life balance with a nine-to-five job in the radiology department, but for emergency interventions, I need a dedicated team with critical-care expertise. Having the scope to build that team was one of the reasons why I wanted an independent department.”
“Providing high-quality, cost-effective care will become increasingly important as we move toward a value-based healthcare environment.”
Make a statement
Second, Defreyne felt the need to make a statement about IR and the role of radiologists in care pathways. He wanted to show the administration board how his interventional treatments reduced length of stay, and thus benefited hospital revenues (in Belgium, government reimbursement depends on the length-of-stay rate per hospital). Defreyne says he also wanted to make the board understand that radiologists have a great deal of expertise and are just as capable of looking after patient health care as other physicians. Finally, he says, it was definitely also a strategic decision. “It would provide me with a budget to invest in new equipment. As head of the IR Department I could manage costs and improve patient care.”
Defreyne had to convince the Administration Board that autonomy was necessary. “IR requires a lot of high-tech equipment. It helped that I could make a strong business case with detailed information on interventional procedures and the hours worked on a single intervention. Every procedure was analyzed in terms of hours and costs. It’s a lot of paperwork, but it’s worth it. IR is the future and robotic surgery is a trend. It’s what makes a hospital attractive to patients.”
Positive patient outcomes
In Ghent, Defreyne also says the IR department achieves more positive patient outcomes. “We are no longer only performing a medical act and sending the patient back to the surgeon who requested the intervention. We now decide ourselves on the treatment and have the informal consent of the colleagues involved. In the case of an aneurysm, for example, we manage the entire follow-up and schedule a postsurgery appointment. For outpatients, we also schedule a check-up after six months. My department is now well known for its professional follow-up services. This has increased patient satisfaction.”
The minimally invasive nature of IR procedures reduces length of stay, and having a separate department where interventional radiologists can take primary responsibility for patient care also reduces delays associated with unnecessary consultations and hand-overs for admissions and discharges. In Ghent, the interventional team decides when a patient can be discharged. Defreyne says his department is known for its short waiting times. “Many scientific papers prove that IR patients are more profitable in terms of length of stay and costs than surgical patients are”, he adds.
Happy staff and patients
The IR Department eventually received its own beds from the hospital’s surgeon commission. This allowed it to admit its own patients, make its own clinical decisions, and provide follow-up care. Each patient benefits from a personal approach. This keeps their hospital stay to the absolute minimum. The IR Department can choose and pay for its own medical equipment and devices. Defreyne explains how this has changed things: “The intake procedure differs and the stay is shorter. The waiting times for patients are also much shorter. We now perform 1,200 outpatient consultations per year. It’s a lot, and there is an upward trend. Apart from the increased patient satisfaction, we noticed our staff are happier, too, because they are now responsible for their patients as well as for their work. As part of the financial evolution, the employees now belong to the IR department, and their salaries are paid from its budget.”
For Defreyne, this is a dream come true. He now has an independent IR department, with its own beds, its own dedicated staff and its own budget. “I hope I have shown them the way forward,” he says. “Providing high-quality, cost-effective care will become increasingly important as we move toward a value-based healthcare environment.”
About the Author
Erika Claessens has contributed as a journalist and editor to numerous print and online publications in both Belgium and the Netherlands. Her main topics are entrepreneurial innovation and technology. She works in Antwerp, Belgium.