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Atri A, Menezes RJ, Boerner SL, Incze T, Ciapanna C, Jia Y, Boci R, Maan KA, Javed W, Ghai S. Long-Term Impact of Thyroid Biopsy Specialists on Efficiency and Quality of Thyroid Biopsy. J Am Coll Radiol 2020; 18:274-279. [PMID: 32768425 DOI: 10.1016/j.jacr.2020.07.011] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/15/2020] [Revised: 07/06/2020] [Accepted: 07/07/2020] [Indexed: 11/19/2022]
Abstract
OBJECTIVE To assess consistency and long-term progress in thyroid biopsy performed by trained sonographers under supervision of a radiologist. METHODS Trained sonographers started performing thyroid biopsy at our institute in August 2011. The data for this study were extracted from a prospectively maintained database for ultrasound guided thyroid biopsy and included the number of thyroid fine needle aspiration biopsy procedures performed between August 2011 and 2016 and the final cytopathology report as per the Bethesda Classification. For the analysis, the study was divided into two time periods: initial postimplementation period (August 2011 to 2013) and late postimplementation period (2014-2016). RESULTS In all, 5,538 thyroid biopsies were performed by trained sonographers in the period, 2,561 in the initial implementation period and 2,977 between 2014 and 2016. The unsatisfactory rates dropped from 21% to 10% in the two periods (P < .001), and the proportion of malignant nodules on cytopathology increased from 6% to 7% in the two periods (P = .010). Wait times for thyroid biopsies remained low during the period. CONCLUSION Sonographers trained to perform ultrasound guided thyroid biopsies provide persistent improved patient care over a long-term period. This reinforces the role of physician extenders in targeted scopes of practice.
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Affiliation(s)
- Alisha Atri
- Joint Department of Medical Imaging, University Health Network-Mount Sinai Hospital-Women's College Hospital, University of Toronto, Toronto, Ontario, Canada
| | - Ravi J Menezes
- Joint Department of Medical Imaging, University Health Network-Mount Sinai Hospital-Women's College Hospital, University of Toronto, Toronto, Ontario, Canada
| | - Scott L Boerner
- Department of Cytopathology, University Health Network, University of Toronto, Toronto, Ontario, Canada
| | - Taylor Incze
- Joint Department of Medical Imaging, University Health Network-Mount Sinai Hospital-Women's College Hospital, University of Toronto, Toronto, Ontario, Canada
| | - Christina Ciapanna
- Joint Department of Medical Imaging, University Health Network-Mount Sinai Hospital-Women's College Hospital, University of Toronto, Toronto, Ontario, Canada
| | - Yongheng Jia
- Joint Department of Medical Imaging, University Health Network-Mount Sinai Hospital-Women's College Hospital, University of Toronto, Toronto, Ontario, Canada
| | - Rudolf Boci
- Joint Department of Medical Imaging, University Health Network-Mount Sinai Hospital-Women's College Hospital, University of Toronto, Toronto, Ontario, Canada
| | - Kulsoom A Maan
- Joint Department of Medical Imaging, University Health Network-Mount Sinai Hospital-Women's College Hospital, University of Toronto, Toronto, Ontario, Canada
| | - Wasim Javed
- Joint Department of Medical Imaging, University Health Network-Mount Sinai Hospital-Women's College Hospital, University of Toronto, Toronto, Ontario, Canada
| | - Sangeet Ghai
- Joint Department of Medical Imaging, University Health Network-Mount Sinai Hospital-Women's College Hospital, University of Toronto, Toronto, Ontario, Canada.
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Schwegel C, Rothman N, Muller K, Loria S, Raunig K, Rumsey J, Fifi J, Oxley T, Mocco J. Meeting the evolving demands of neurointervention: Implementation and utilization of nurse practitioners. Interv Neuroradiol 2018; 25:234-238. [PMID: 30269668 DOI: 10.1177/1591019918802411] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Abstract
Growth in the neurointerventional field, as a result of the emergence of thrombectomy as the gold standard treatment for large vessel occlusions, has created complex challenges. In an effort to meet evolving demands and fill workflow gaps, nurse practitioners have taken on highly specialized roles. Neurointerventional care has rapidly evolved similarly to interventional cardiac care, in that nurse practitioners are successfully being incorporated as procedural assistants in catheterization laboratories. Similar utilization of nurse practitioners in interventional neuroradiology holds the capacity to decrease physician workload, mitigate stresses contributing to burn-out, and reallocate more physician time to procedures. Nurse practitioner practice faces procedural, clinical, legal and interpersonal barriers. Despite calls for expanded practice by the Institutes of Medicine, a paucity of nurse practitioner training opportunities exists. Fragmented privileging processes contribute to environments where nurse practitioners must navigate hurdles without established interventional neuroradiology-specific precedent. Increased nurse practitioner mentorship, fluoroscopy law standardization, physician support surrounding nurse practitioner autonomy, and role consistency is imperative for optimal nurse practitioner utilization. Nurse practitioners are uniquely equipped to bridge evolving gaps through the provision of safe, efficacious care, and generating revenue at lower costs. Discussion surrounding nurse practitioner use to bridge workflow gaps is an exciting opportunity for future practice development.
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Affiliation(s)
- Claire Schwegel
- 1 The Mount Sinai Health System, Cerebrovascular Center, New York, NY, USA
| | - Nicole Rothman
- 2 Columbia University Medical Center, School of Nursing, New York, NY, USA
| | - Kimberly Muller
- 2 Columbia University Medical Center, School of Nursing, New York, NY, USA
| | - Stephanie Loria
- 2 Columbia University Medical Center, School of Nursing, New York, NY, USA
| | - Katherine Raunig
- 2 Columbia University Medical Center, School of Nursing, New York, NY, USA
| | - Jamie Rumsey
- 1 The Mount Sinai Health System, Cerebrovascular Center, New York, NY, USA
| | - Johanna Fifi
- 1 The Mount Sinai Health System, Cerebrovascular Center, New York, NY, USA
| | - Thomas Oxley
- 1 The Mount Sinai Health System, Cerebrovascular Center, New York, NY, USA
| | - J Mocco
- 1 The Mount Sinai Health System, Cerebrovascular Center, New York, NY, USA
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Nandwana SB, Walls DG, Ibraheem O, Murphy F, Tridandapani S, Cox K. Beyond complications: Comparison of procedural differences and diagnostic success between nurse practitioners and radiologists performing image-guided renal biopsies. J Am Assoc Nurse Pract 2016; 28:554-558. [PMID: 27183896 DOI: 10.1002/2327-6924.12376] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/23/2015] [Accepted: 03/21/2016] [Indexed: 11/05/2022]
Abstract
PURPOSE Radiology-trained nurse practitioners (NPs) may perform image-guided medical renal biopsies with computed tomography (CT). This study evaluates the procedural differences and diagnostic success between biopsies performed by NPs compared to radiologists. DATA SOURCES A retrospective study was performed on patients who underwent nontargeted, CT-guided renal biopsy between 2009 and 2014. Provider type (NP or radiologist), number of core specimens obtained, sedation medication dose, CT dose index (CTDI), and diagnostic success were recorded. Categorical and continuous variables were analyzed using χ2 and Student's two-tailed t-test, respectively, comparing NPs with radiologists. CONCLUSIONS A total of 386 patients were included; radiologists performed 215 biopsies and NPs performed 171 biopsies. There was no significant difference in diagnostic success, amount of tissue harvested (number of cores), radiation dose, or sedation dosage between NPs and radiologists performing CT-guided renal biopsies. Only 4% were nondiagnostic (n = 7, radiologists; n = 9, NPs; p = .325). Overall mean number of cores obtained was 3.7, mean CTDI was 176.5 mGy, mean fentanyl dose was 86.3 μg, and mean midazolam was dose 1.54 mg without a statistically significant difference between provider types. IMPLICATIONS FOR PRACTICE NPs perform image-guided medical renal biopsies in a similar fashion to radiologists with respect to diagnostic success, amount of tissue harvested, total radiation dose exposure, and administration of sedation.
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Affiliation(s)
- Sadhna B Nandwana
- Department of Radiology and Imaging Sciences, Emory University, Atlanta, Georgia.
| | - Deborah G Walls
- Department of Radiology and Imaging Sciences, Emory University, Atlanta, Georgia
| | - Oluwayemisi Ibraheem
- Department of Radiology and Imaging Sciences, Emory University, Atlanta, Georgia
| | - Frederick Murphy
- Department of Radiology and Imaging Sciences, Emory University, Atlanta, Georgia
| | - Srini Tridandapani
- Department of Radiology and Imaging Sciences, Emory University, Atlanta, Georgia
| | - Kelly Cox
- Department of Radiology and Imaging Sciences, Emory University, Atlanta, Georgia
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Ghai S, Lee SY, Bret PM, Menezes RJ, Boerner SL, Jia Y, Maan KA, Boci R, Javed W, Atri M. Thyroid Biopsy Specialists: A Quality Initiative to Reduce Wait Times and Improve Adequacy Rates. Radiology 2015; 276:894-9. [PMID: 25897472 DOI: 10.1148/radiol.2015140620] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Abstract
PURPOSE To develop and implement a program where selected sonographers would be trained to perform thyroid biopsies independently under the supervision of a radiologist, with the goal of improving efficiency and quality. MATERIALS AND METHODS Institutional research ethics board approval was obtained for this retrospective study, with waiver of informed consent. After approval from the relevant regulatory bodies, four sonographers successfully completed a training program and began to perform all thyroid biopsies (with informed consent) in a room adjacent to the main radiologist-run biopsy room, where the radiologist was available for backup as needed. In the preimplementation period (January 2010 to April 2011), 1321 nodules were biopsied, 29 of which included on-site cytopathology assessment. In the postimplementation period (August 2011 to July 2012), 1347 nodules were biopsied, 103 of which underwent on-site cytopathology assessment. Wait times and adequacy rates were calculated for both periods. RESULTS Patient wait times decreased from a mean of 80-90 days before implementation of the thyroid biopsy specialist program to 20-30 days afterward. The percentage of adequate samples improved from 74.6% (985 of 1321 nodules) to 78.6% (1059 of 1347 nodules), with a P value of .015 (74.1% [957 of 1292 nodules] to 77.5% [964 of 1244 nodules] when excluding nodules with on-site cytopathology assessment, P = .0497). The percentage of malignant samples showed no significant change in the two time periods, 5.1% (68 of 1321 nodules) before implementation of the program versus 5.4% (73 of 1347 nodules) after implementation, P = .823 (5.1% [66 of 1292 nodules] vs 5.3% [66 of 1244 nodules] in the respective time periods when excluding nodules with on-site cytopathology assessment, P = .888). No major procedural complications occurred. CONCLUSION Sonographers can be successfully trained to perform ultrasonography-guided thyroid biopsies safely under the supervision of a radiologist, which can improve wait times and adequacy rates.
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Affiliation(s)
- Sangeet Ghai
- From the Joint Department of Medical Imaging, University of Toronto, University Health Network, Mount Sinai Hospital-Women's College Hospital, Toronto General Hospital, 585 University Ave, Toronto, ON, Canada M5G 2N2 (S.G., S.Y.L., P.M.B., R.J.M., Y.J., K.A.M., R.B., W.J., M.A.); and Department of Cytopathology, University of Toronto, University Health Network, Toronto General Hospital, Toronto, Ont, Canada (S.L.B.)
| | - Stefanie Y Lee
- From the Joint Department of Medical Imaging, University of Toronto, University Health Network, Mount Sinai Hospital-Women's College Hospital, Toronto General Hospital, 585 University Ave, Toronto, ON, Canada M5G 2N2 (S.G., S.Y.L., P.M.B., R.J.M., Y.J., K.A.M., R.B., W.J., M.A.); and Department of Cytopathology, University of Toronto, University Health Network, Toronto General Hospital, Toronto, Ont, Canada (S.L.B.)
| | - Patrice M Bret
- From the Joint Department of Medical Imaging, University of Toronto, University Health Network, Mount Sinai Hospital-Women's College Hospital, Toronto General Hospital, 585 University Ave, Toronto, ON, Canada M5G 2N2 (S.G., S.Y.L., P.M.B., R.J.M., Y.J., K.A.M., R.B., W.J., M.A.); and Department of Cytopathology, University of Toronto, University Health Network, Toronto General Hospital, Toronto, Ont, Canada (S.L.B.)
| | - Ravi J Menezes
- From the Joint Department of Medical Imaging, University of Toronto, University Health Network, Mount Sinai Hospital-Women's College Hospital, Toronto General Hospital, 585 University Ave, Toronto, ON, Canada M5G 2N2 (S.G., S.Y.L., P.M.B., R.J.M., Y.J., K.A.M., R.B., W.J., M.A.); and Department of Cytopathology, University of Toronto, University Health Network, Toronto General Hospital, Toronto, Ont, Canada (S.L.B.)
| | - Scott L Boerner
- From the Joint Department of Medical Imaging, University of Toronto, University Health Network, Mount Sinai Hospital-Women's College Hospital, Toronto General Hospital, 585 University Ave, Toronto, ON, Canada M5G 2N2 (S.G., S.Y.L., P.M.B., R.J.M., Y.J., K.A.M., R.B., W.J., M.A.); and Department of Cytopathology, University of Toronto, University Health Network, Toronto General Hospital, Toronto, Ont, Canada (S.L.B.)
| | - Yongheng Jia
- From the Joint Department of Medical Imaging, University of Toronto, University Health Network, Mount Sinai Hospital-Women's College Hospital, Toronto General Hospital, 585 University Ave, Toronto, ON, Canada M5G 2N2 (S.G., S.Y.L., P.M.B., R.J.M., Y.J., K.A.M., R.B., W.J., M.A.); and Department of Cytopathology, University of Toronto, University Health Network, Toronto General Hospital, Toronto, Ont, Canada (S.L.B.)
| | - Kulsoom A Maan
- From the Joint Department of Medical Imaging, University of Toronto, University Health Network, Mount Sinai Hospital-Women's College Hospital, Toronto General Hospital, 585 University Ave, Toronto, ON, Canada M5G 2N2 (S.G., S.Y.L., P.M.B., R.J.M., Y.J., K.A.M., R.B., W.J., M.A.); and Department of Cytopathology, University of Toronto, University Health Network, Toronto General Hospital, Toronto, Ont, Canada (S.L.B.)
| | - Rudolf Boci
- From the Joint Department of Medical Imaging, University of Toronto, University Health Network, Mount Sinai Hospital-Women's College Hospital, Toronto General Hospital, 585 University Ave, Toronto, ON, Canada M5G 2N2 (S.G., S.Y.L., P.M.B., R.J.M., Y.J., K.A.M., R.B., W.J., M.A.); and Department of Cytopathology, University of Toronto, University Health Network, Toronto General Hospital, Toronto, Ont, Canada (S.L.B.)
| | - Wasim Javed
- From the Joint Department of Medical Imaging, University of Toronto, University Health Network, Mount Sinai Hospital-Women's College Hospital, Toronto General Hospital, 585 University Ave, Toronto, ON, Canada M5G 2N2 (S.G., S.Y.L., P.M.B., R.J.M., Y.J., K.A.M., R.B., W.J., M.A.); and Department of Cytopathology, University of Toronto, University Health Network, Toronto General Hospital, Toronto, Ont, Canada (S.L.B.)
| | - Mostafa Atri
- From the Joint Department of Medical Imaging, University of Toronto, University Health Network, Mount Sinai Hospital-Women's College Hospital, Toronto General Hospital, 585 University Ave, Toronto, ON, Canada M5G 2N2 (S.G., S.Y.L., P.M.B., R.J.M., Y.J., K.A.M., R.B., W.J., M.A.); and Department of Cytopathology, University of Toronto, University Health Network, Toronto General Hospital, Toronto, Ont, Canada (S.L.B.)
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Murphy FB, Walls G, Tridandapani S, Ibraheem O, Bowen M, Bressler S, Yamada K, Small W. Comparison of image-guided nonfocal hepatic biopsies performed by physicians and nurse midlevel providers. J Am Coll Radiol 2014; 11:1059-63. [PMID: 24889475 DOI: 10.1016/j.jacr.2014.03.021] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/29/2014] [Accepted: 03/30/2014] [Indexed: 12/17/2022]
Abstract
Image-guided hepatic biopsies have been performed safely and accurately for a number of years. The advantages of sonographic or CT guidance in avoiding major vital structures, such as large vessels, the gallbladder, or pleura, have been confirmed many times. However, the safety and accuracy of certified nurse practitioners' performing these biopsies have not been described. The authors describe a retrospective review of 418 image-guided hepatic biopsies that demonstrated no significant difference in accuracy or complication rates between biopsies performed by certified nurse practitioners and those performed by radiologists in a single-institution, multihospital academic setting. Appropriately trained advanced practice providers can perform image-guided hepatic biopsies safely and accurately.
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Affiliation(s)
- Frederick B Murphy
- Department of Radiology and Imaging Sciences, The Emory University School of Medicine, Atlanta, Georgia.
| | - Gail Walls
- Department of Radiology and Imaging Sciences, The Emory University School of Medicine, Atlanta, Georgia
| | - Srini Tridandapani
- Department of Radiology and Imaging Sciences, The Emory University School of Medicine, Atlanta, Georgia
| | - Oluwayemisi Ibraheem
- Department of Radiology and Imaging Sciences, The Emory University School of Medicine, Atlanta, Georgia
| | - Michael Bowen
- Department of Radiology and Imaging Sciences, The Emory University School of Medicine, Atlanta, Georgia
| | - Suzanne Bressler
- Department of Radiology and Imaging Sciences, The Emory University School of Medicine, Atlanta, Georgia
| | - Kei Yamada
- Department of Radiology and Imaging Sciences, The Emory University School of Medicine, Atlanta, Georgia
| | - William Small
- Department of Radiology and Imaging Sciences, The Emory University School of Medicine, Atlanta, Georgia
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Duszak R, Chatterjee AR, Schneider DA. National fluid shifts: fifteen-year trends in paracentesis and thoracentesis procedures. J Am Coll Radiol 2011; 7:859-64. [PMID: 21040867 DOI: 10.1016/j.jacr.2010.04.013] [Citation(s) in RCA: 59] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/18/2010] [Accepted: 04/13/2010] [Indexed: 12/30/2022]
Abstract
PURPOSE The aim of this study was to evaluate national trends in paracentesis and thoracentesis procedures and the relative roles of specialty groups providing these services. METHODS Medicare Physician Supplier Procedure Summary Master Files from 1993 to 2008 were analyzed for paracentesis and thoracentesis procedure codes. Using physician specialty identifier codes, procedure volumes were extracted for radiologists, primary care physicians, and surgeons for both procedures. Volume data were extracted for gastroenterologists and pulmonary and critical care medicine physicians, respectively, for paracentesis and thoracentesis. Frequency by site of service was similarly evaluated. Relative changes were calculated. RESULTS Between 1993 and 2008, paracentesis procedures on Medicare fee-for-service beneficiaries increased by 133% (from 64,371 to 149,699), and thoracentesis procedures decreased by 14% (from 147,363 to 127,444). Services by radiologists increased by 964% (from 10,456 to 111,275) and 358% (from 14,531 to 66,602), respectively, while all other targeted groups experienced declines. For paracentesis, radiologist and gastroenterologist procedure shares changed from 16% and 32%, respectively, in 1993 to 74% and 6% in 2008. For thoracentesis, radiologist and pulmonary and critical care medicine physician shares changed from 10% and 49% to 52% and 27%. Relative shifts in site of service to the hospital outpatient setting occurred for both procedures. CONCLUSIONS Since 1993, paracentesis procedures on Medicare beneficiaries have more than doubled, while thoracentesis volumes have declined slightly. Radiologists now far exceed gastroenterologists and pulmonary and critical care medicine physicians, respectively, as the predominant providers of these services. Those shifts are likely attributable to both the incremental safety of imaging guidance and also the unfavorable economics of these procedures.
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Affiliation(s)
- Richard Duszak
- Mid-South Imaging and Therapeutics, Memphis, Tennessee 38120, USA.
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