Extended Role of the Radiologic Technologist in a Pediatric Interventional Suite
Albert Aziza, BS, BHA, MRT(R)
*Manager of Image Guided Therapy, The Hospital for Sick Children, Toronto, Ontario.
Address correspondence to: Albert Aziza, BS, BHA, MRT(R), Manager of Image Guided Therapy, The Hospital for Sick Children, 555 University Avenue, Toronto, Ontario, Canada M5G1X8. E-mail: albert.aziza@sickkids.ca.
The Hospital for Sick Children is a 300-bed tertiary care academic facility in Toronto, Ontario, treating 300 000 pediatric patients annually, who are referred from across the country and often beyond its borders. The Image Guided Therapy (IGT) center was built in 2001 to respond to an increased demand from physicians and patients for minimally invasive procedures using imaging guidance. The center has flourished under the administrative management and support of the diagnostic imaging department. It has become one of the major places of treatment for patients who are too sick to undergo traditional open surgery or, more commonly, because the therapeutic procedures most appropriate to treat their conditions are best performed by the multidisciplinary team of healthcare professionals working in the IGT center.
The suite includes 4 procedure rooms that have state-of-the-art equipment: 3 single-plane fluoroscopy units, 1 double-plane unit mainly used for neuro-interventions, 1 computed tomography (CT) scan with CT-Fluoro capacity, and 3 ultrasound units. The suites also have been designed with laser protection equipment and laparoscopy/endoscopy cameras. They were all built to operating room standards for infection control requirements. Additionally, combined procedures involving an interventional radiologist working side by side with a surgeon or another medical professional to perform multiple procedures on the same patient under a general anesthetic has become reality. This process has even become the current standard of care in the organization and takes place on a daily basis.
In the past 5 years, the hospital has experienced a 15% to 20% annual increase in patient volume, coupled with an increased acuity of the health of the patient population, which has brought some challenges to successfully managing the unit at a time when the North American market is experiencing a critical shortage in healthcare experts. As an integral part of the original team, the radiologic technologists (RTs) have had to evolve from their traditional role as imaging experts to a more sophisticated position by acquiring new skills that were needed to improve the efficiency of the center.
The unit staffs 5 pediatric interventional radiologists supported by 2 fellows and a pediatrician. Additionally, there are 10 registered nurses, including 1 who covers an interventional clinic that assesses patients before procedures, and 1 whose role is to prioritize and assess the requests for vascular access in the hospital. Several support staff also manage the reception, bookings, and housekeeping needs of the suite.
The original group of 7 RTs hired to support the sophisticated imaging needs of the unit are still employed 5 years after opening. The criteria included having experience in another imaging specialty, such as CT or ultrasound, and the willingness to manage various tasks that do not fit the traditional job description of an RT. These enthusiastic individuals were willing to adopt a different perspective of their profession and their relationship with the other healthcare professionals working with them. They were open to learning new skills, in addition to accepting a new work culture that is fast-paced and subject to frequent operational changes.
The RTs in the IGT center are expected to oversee the functionality and maintenance of the state-of-the-art digital imaging equipment. Their primary role is to support the radiologists and other medical staff using the equipment to perform procedures by providing optimal resolution of the image. Controlling patients' dosage, in addition to ensuring that radiation protection safety guidelines were implemented in the rooms, is also part of their daily tasks.
The relationship between RTs and nurses has been a difficult topic for both professions for many years. Traditionally, RTs outnumber the nursing staff in the diagnostic imaging department, whereas the reverse situation is true in the IGT suites. To overcome this challenge, a shift in the RT and nursing culture within the hospital had to occur. Gaining recognition and acceptance from the nursing management infrastructure to perform duties that were historically the domain of the nursing staff became natural after the RTs were able to prove their competency and skills.
RTs were also given the task of managing the complex inventory system of IGT. In addition, they were familiarized with aseptic techniques and were able to assist the radiologists by scrubbing in with them or circulating the room, providing supplies to the trays in a sterile manner.
Finally, because of their strong organizational skills, sense of productivity, and efficient flow of patients, the RTs were chosen for the central command role of running a board that lists up to 25 patients a day, all of whom are undergoing complex procedures. On a daily basis, these trained RTs assign another RT to cases and discuss the priority of any urgent addition to the board. Anesthesiologists also rely on guidance from this "super tech," who designates them to the room best fitted to perform a particular procedure and discusses the type of anesthetic agent that would benefit the child best. Medical staff often welcome discussing the relevance of performing certain procedures with this highly trained individual, especially when radiologists are unavailable because they are busy attending to patients.
The transition to a new advanced practice role for RTs was facilitated by the help of every member of the multidisciplinary team working in the unit. By allowing RTs to learn new skills, the nurses and physicians working in IGT have opened the door to allow change in an RT's culture and practice. This has resulted in an increase in the efficiency and quality of care provided in the department.
In the near future, medical directives and a program allowing RTs and nurses to perform minimally invasive procedures using image guidance will be introduced for the first time in IGT. This new project has been received with enthusiasm by all staff working in the department. At a broader level, this is confirming the trend that is occurring in the healthcare industry. Healthcare providers are increasingly allowed to perform tasks that traditionally were performed by physicians. RTs are part of this group of highly competent and accountable individuals who are proud to play an increasingly important role in the care plan of their patients.
Image:
One of the 4 rooms in the Image Guided Therapy department at The Hospital for Sick Children in Toronto, Ontario. The room is designed to meet operating room standards and contains a computed tomography scan, a digital fluoroscopy unit, an ultrasound unit, and a light source used for laparoscopy.
