CVForward > Are you offering transradial interventions in your cath lab?
Transradial intervention (TRI) is gaining support in literature and in cath labs across the United States. As healthcare evolves from fee-for-service to value-based care, the advantages of TRI over traditional transfemoral intervention represent an opportunity for better alignment between administrative goals and patient care. In fact, there is mounting evidence that TRI can improve clinical and economic outcomes, enhances lab efficiencies, and increases patient satisfaction metrics.1
For some, however, the prospect of transitioning from transfemoral to TRI may seem daunting, despite the promise of significant benefits. Barriers to TRI implementation include lack of training, reservations about disrupting the current case flow, and prolonged fluoroscopy time while gaining proficiency.2 Gordon Wesley, Cardiovascular Service Line Administrative Director at Ascension St. Vincent’s Health System, is an early champion of TRI and maintains that its benefits far outweigh the challenges and risks.
Gordon, who helped launch transradial programs at two of the system’s acute care hospitals, witnessed firsthand their successful implementation. One hospital, Ascension St. Vincent’s East, increased their radial caseload to nearly 80% in just 3 years and continues to maintain that number today.
Gordon B. Wesley, DBA, FACHE
System Cardiovascular Service Line Administrative Director at Ascension St. Vincent’s Health System and Admin Chair of the National Cardiovascular Service Line, Ascension
Employing a TRI strategy in the cath lab can impact the cost drivers typically associated with transfemoral access. Studies show that TRI reduces bleeding and vascular complications, increases lab throughput, improves staff utilization, and in many cases, enables same-day discharge—all of which reduce costs per case.
Gordon emphasizes that it is the combination of TRI procedural efficiencies and same-day discharge that provides institutions the highest level of economic benefit. He also stresses the importance of case volume: “Labs must see enough backfill cases to fill the vacancy created by same-day discharge. This is where you will see the greatest impact.”
The economic impact of transradial procedures and same-day discharge was recently published in JACC: Cardiovascular Interventions. The study showed cath labs that perform more transradial, same-day percutaneous coronary interventions (PCIs), could collectively save hospitals $300 million each year.3
With the increasing focus on patient-centric care and reimbursement models more closely tied to patient satisfaction metrics, it’s never been a better time for TRI. For many patients, the advantages over transfemoral interventions have made radial a preferred access site. A positive patient experience may also lead to a greater number of referrals and, ultimately, increased case volume.4,5
Gordon B. Wesley, DBA, FACHE
A wide range of stakeholders value radial access procedure.
The first step in planning and implementing a TRI program is to gain alignment among key stakeholders, secure their commitment, and confirm their continued support. According to Gordon, the radial programs implemented at Ascension St. Vincent’s Health System were built from the ground up and required the focused and concentrated efforts of all involved.
Gordon reasoned that implementation is much smoother when stakeholders agree on the strategic imperatives of the program. He explains, “We knew that TRI was likely to become the new standard of care for cardiac intervention and that its benefits aligned with benchmarks for improved clinical outcomes, cost efficiencies, and patient satisfaction. It was our vision for the future.”
Involve all members of the team in the planning and execution of the radial program:
About 80% of the cardiac catheterization procedures performed at the St. Vincent East Campus facility use TRI. Gordon admits that number was not achieved overnight. “Once we gained alignment, we built a team that had a considerable bandwidth of expertise and ensured all support staff was proficient. We established a pre- and post-operative vascular care unit adjacent to the catheterization lab—literally a few feet away. it didn't hurt that we have exceptional physicians throughout the system.
Gordon explains, “Instituting a wholesale change can be challenging, so it’s important that everyone be set up for success. Being able to observe and care for these patients in such close proximity to the catheterization lab enhances safety, boosts confidence, and improves throughput and efficiency.
Gordon B. Wesley, DBA, FACHE
Successfully implementing a TRI program requires that the cardiac catheterization team, including operators, procedural nurses, and technologists, train by following the same protocols. There are now a number of educational resources to choose from, making it easier for teams to locate preferred platforms and convenient times to train. They include hands-on workshops, didactic sessions, symposia, web-based tutorials, open dialogues, and one-on-one sessions.
It’s important to manage expectations among key stakeholders, particularly in the initial stages of implementation. Studies show that a TRI learning curve does exist in current US practice. However, as operators gain TRI experience, they are able to select more complex patients without sacrificing procedure success or increasing radiation exposure and contrast use6.
Many experts believe that the threshold for becoming proficient in the radial procedure in the United States is 30 to 50 cases. It is recommended that radial access be implemented gradually rather than abruptly to avoid inefficiency, frustration, or a loss of enthusiasm. Initial volume should be slow and steady to include elective, diagnostic cases as well.
As TRI gains acceptance and more hospitals and cath labs adopt this approach, it will ultimately enable more patients, teams, and institutions to bring the benefits of this new standard of cardiac care to life.
Visit these websites for more helpful information from other industry thought leaders.
By The Cardiology Advisor
This article summarizes a recent JACC study showing that TRI with same-day discharge is associated with lower cost-to-charge ratio.
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Find out why TRI is beneficial for women, despite the potential for technical challenges.
By Michael O’Riodoran
Despite phychological barriers for operators using the same radial artery, switching to femoral access for repeat patients is not necessary.
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