SIR 2024
Embolization
Robert Elliott, DO
Assistant Professor of Interventional Radiology
University of Rochester
Financial relationships: Full list of relationships is listed on the CME information page.
Kate Clancy, DO, MPH
Resident
University of Rochester
Financial relationships: Full list of relationships is listed on the CME information page.
Michael Vella, MD
Assistant Professor of Acute Care Surgery and Trauma
URMC
Disclosure information not submitted.
Cantos J. Andrew, MD
Attending Physician / IR Residency Program Director
University of Rochester/Strong Memorial Hospital
Disclosure information not submitted.
Evaluation of critical embolization response teams (CERT) and their impact on the time from interventional radiology (IR) consult to puncture time for trauma patients.
Materials and methods:
Following institutional review board approval, a retrospective review of trauma angiograms was performed from October 2022 through September 2023. The time from consult to puncture was measured, as well as response components: consult until activation (activation), activation until nursing handoff (response), nursing handoff until in room (transport), and in room until puncture (room time). CERT responses were activated by the trauma service for patients with a positive CT angiogram and blood pressure less than 90 mmHg, shock index greater than 1, or transfusion requirement in the previous 24 hours. After CERT activation, IR teams would begin preparation with transport direct to IR by emergency department, trauma ICU, or IR. Prior to CERT, transport of patients was performed by centralized hospital transport. A two-sample t-test was used to compare response times pre- and post- CERT implementation.
Results:
71 trauma responses were reviewed. 19 were excluded for one of the following reasons: consultation not occurring in the first 24 hours, delayed response for patient monitoring, or unknown initial consult time. In the pre-intervention group, 25 cases met inclusion criteria; of these 15 were retrospectively identified as CERT responses. In the post-intervention group, 27 cases met inclusion criteria; of these 18 were identified as CERT. The mean consult to puncture time for patients that met CERT criteria in the pre-intervention group was 121 minutes compared to 107 minutes in the post-intervention group; a decrease of 13 minutes (95% CI -9.2, 36.4 minutes; p=0.23). In the individual components, there was reduction in activation time of 5 minutes (15 to 10 minutes, 95% CI -6.0, 15.0; p=0.39), response time of 19 minutes (41 to 22 minutes, 95% CI 5.1, 33.2; p< 0.01), and room time of 6 minutes (31 to 25 minutes, 95% CI -3.1,14.3; p=0.20). There was an increase in transport time of 16 minutes (33 to 49 minutes, CI: -27.1, -4.0; p=0.01).
Conclusion:
Implementation of the CERT protocol reduced time from IR consult to puncture, although only the response component was found to be statistically significant. Transport time was the largest driver of the overall response and increased during the study period. The findings suggest that transport should be an area of focus, and that this component of the response might be more resistant to early improvement for others undergoing similar quality initiatives.