BSIRQI Site Assessment Proforma
Using this form:
The questionnaire is designed to allow Interventional Radiology departments to assess their services over four domains; defining scope of services, providing good quality care, patient focus and service improvement. Services that are already fulfil the key domains will be eligible for inclusion as an exemplar site. Some services will need to work towards achieving the key domains and these departments are invited to submit for inclusion as a pilot site.
Please click on the grey section after the question and a checkbox, dropdown or textbox will be available for entry. Save the form with a filename that indicates your site.
This questionnaire should be submitted by email to . We aim to acknowledge receipt of all submitted forms within 3 working days.
Further information about quality improvement is available at www.bsir-qi.org
Definitions:
Local lead for this BSIRQI site: a clinician that takes responsibility for the quality of Interventional Radiology services. This does not need to be the local clinical lead or clinical director
Formal rota: a rota that is distributed in advance with a named radiologist and contact details for each on-call period
Adhoc rota: any system that permits contact with a list of radiologists who are not on-call but may be available to undertake intervention
Formal network pathway: a documented patient pathway between two separate hospitals that has been agreed and signed off by both parties.
BSIRQI Site Assessment Proforma
Name of person completing this form Tony Watkinson Date of Completion November 2011
Contact email:
Name of local lead for this BSIRQI site Tony Watkinson
Contact email :
About your hospital
Name of hospital Royal Devon and Exeter Hospital
Type of hospital: Large Teaching Hospital (>500 beds) Medium Teaching Hospital (<500 beds) Medium Non Teaching Hospital Other
Number of radiologists overall 16 Number of Interventional Radiologists 3
What referral services does you service cover?
Referral service / Referral service / Referral serviceAcute Medical / Pls indicateYesNo / Acute Surgical / Pls indicateYesNo / Urology services / Pls indicateYesNo
Major Trauma / Pls indicateYesNo / Gastrointestinal Bleeding / Pls indicateYesNo / Renal Services / Pls indicateYesNo
Renal dialysis / Pls indicateYesNo / Obstetric services / Pls indicateYesNo / Gynaecology services / Pls indicateYesNo
Oncology Services / Pls indicateYesNo / Transplant / Pls indicateYesNo
Domain: Defining Scope of Services
What services does your IR service provide in hours?
Procedure / Provided in this hospital / Formal referral pathway to neighbouring centre / No provision and no formal pathwayNephrostomy
Ureteric stenting
Biliary drainage / stenting
Oesophageal / colonic stenting
Endovascular Intervention (angioplasty/stent /thrombolysis)
Embolization- haemorrhage
TIPSS
EVAR
TEVAR
Uterine Fibroid Embolization
TACE
Renal access intervention
Tunnelled central venous catheter insertion
IVC filter insertion
What services does your IR service provide 24/7?
Procedure / Formal Rota / Adhoc rota / Not availableNephrostomy
Endovascular Intervention
Embolization
TIPSS
E- TEVAR
E-EVAR
IVC filter insertion
If you do not provide IR services 24/7 do you have formal written agreements and protocols with a neighbouring centre?
Procedure / Formal written Network / Recipient centreNephrostomy / Please indicateYesNo
Endovascular Intervention / Please indicateYesNo
Embolization / Please indicateYesNo
TIPSS / Please indicateYes
E-TEVAR / Please indicateYesNo
E-EVAR / Please indicateYesNo
IVC filter insertion / Please indicateYesNo
Domain: Providing good quality care
Which of the following does your service participate in?
Weekly / Monthly / Bimonthly / OtherDepartmental discrepancy meeting
Multidisciplinary team meeting
Morbidity and Mortality Meeting
Has your service conducted an audit of the above meetings in the last year?
Departmental Discrepancy / Multidisciplinary team / Morbidity and MortalitySpecify the nature and outcome of the audit
Which of the following registries has you service contributed to in the last 6 months?
Registry / Registry / RegistryBIAS Iliac Angioplasty / Biliary / NVD: AAA/EVAR
International Spinal Plasty / International Colorectal
Domain: Patient focus
Does your service provide written patient information for IR procedures? 100% 75% 50% 25%
What is the source for written information: In house RCR/ BSIR
Has your service conducted an audit of patient information in the last year? Yes No
Please specify the nature and outcomes of this audit
Several of the information leaflets have been rewritten and updated
Does your service provide an Interventional Clinic? Yes No
If yes frequency: Weekly Biweekly Monthly
Does your service use the NPSA/WHO Safe Surgery (IR) checklist? Yes No
Has your service audited the use of the NPSA Safe Surgery check list in the last year? Yes No
Domain: Service Improvement
We are keen that exemplar sites provide examples of service improvement in Interventional Radiology that we can share on the website and with other hospital sites. Your example should provide a solution that improved the local Interventional Radiology service. The example might for example describe how you have better utilized stock or solved a staffing issue etc.
Please submit at least one example of service improvement using the following headings:
What was the problem?
information leaflets not available for all procedures. patients attending for procedures not well informed
What changes did you make?
comprehensive rewriting of information leaflets for all procedures. These now include an "Assent to treatment" section at the end of all leaflets. The patient is given the information leaflet at the outpatient consultation. They take away the leaflet and after reading the leaflet they sign a section at the end, date it and return it prior to the procedure being performed. This is then scanned in the notes. The assent states that the patient has read the patient information leaflet, understands the procedure and what it entails and agrees to undergo treatment. This then makes the formal consent process more straightforward.
What were the key steps in making the changes happen?
division of workload of rewriting leaflets amongst all the IR's to share the work burden
What improvements have you seen?
patients better informed
What would you do differently?
Increase support for data entry
Based on your responses to the questions please indicate which category you think your service fulfills
Exemplar site: already fulfills the main domains above
Pilot site: cannot currently fulfill the domains but committed to working towards improvement
Further comments
Data is also entered into the NVD for carotid stenting procedures, TEVAR and FEVAR. We also contributed to the RCR nephrostomy audit and the BSIR UFE registry.
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