Poster number 1763974 Advanced Practice in Interventional Radiology An Overview of the Current Practice of Radiographers and Nurses Gillian Hamlett¹, Richard Hoddes¹, Eleanor Mort¹ & Nicholas Chalmers¹. ¹Clinical Radiology, Manchester Royal Infirmary, Central Manchester University Hospitals NHS Foundation Trust.

BACKGROUND AND RATIONALE • Advanced practice (AP) within radiography is well established, with a solid evidence base available in the literature1-5. • Despite anecdotal evidence of advanced practice within Interventional Radiology (IR), there is little or nothing in the literature to support this. • The Society & College of Radiographers (SCoR) Scope of Practice6 found that 26% of departments have radiographers performing ‘image guided interventions’. However, the response rate was low and the detail lacking. • It was therefore decided to conduct a scoping exercise, particularly focused on advanced practice within IR, with the intention of providing a baseline for future work.

METHODS Types of Procedure, by Professional Group DISCUSSION • A survey was constructed using the Survey Monkey •The response rate for this survey was better (≈50%) than that website7. This was a cross-sectional cohort study8, received by the SCoR (11%)6 and the findings more specific to targeting those working in Interventional Radiology. IR. • The distribution was over two months (Aug-Sept 2013) •The distribution strategy introduced selection bias; not all IR through the British Society of Interventional Radiology Radiologists are members of BSIR, not all IR Radiographers (BSIR), Society of Interventional Radiology Nurses and or IR Nurses are members of SIRNR. Radiographers (SIRNR) and SCoR9 memberships, •This data provides a baseline for future research (as part of a supplemented with targeted use of social media10. longitudinal study) or for benchmarking (between Trusts, or • An initial pilot cohort revealed the need to modify the survey; internationally). this was done before the general distribution. •The data demonstrates that Advanced Practice within IR is prevalent within the UK. This is at odds with the amount of literature available. RESULTS •Advanced Practitioners working within IR need to be more • 107 respondents, representing 85 centres: vociferous; promote themselves and publish more.

• 50.6% (n=43) had non-medics performing interventional Figure 1 •With Advanced Practice occurring so widely, forums (such as procedures (Radiographers 30.2%, n=13; Nurses 41.9%, SIRNR) need to become more pro-active. n=18; both 27.9%, n=12). •Reasons given by centres who do not have non-medics Scope of Practice (Figure 1). performing IR procedures vary, but common themes emerged, • Of those centres which had non-medics performing see Fig.3. procedures, over half included vascular access (PICC, Methods of Training (%) tunnelled lines, portacaths). • Second to vascular access was diagnostic imaging (diagnostic angiograms, fistulagrams, venograms and THE MANCHESTER ROYAL INFIRMARY EXPERIENCE HSGs). 2000-2001 a multi-disciplinary team of Senior Nurses and Vascular Diagnostic % % Senior Radiographers undertake in-house training in Access Imaging Radiographers 7 19.4 14 87.5 peripheral angiography and tunnelled central lines.

Nurses 20 55.6 2 12.5 Figure 2 Waiting times for these procedures reduce dramatically. Both 9 25.0 0 0 Now all AP is undertaken by Senior Radiographers due to

staff attrition in the nursing team. At two centres Radiographers perform facet joint injections On-going audit shows complication and radiation dose rates and there are isolated incidences of radiographers Reasons Given for Absence of Advanced Practice at a low level, comparable to Consultant Radiologists. performing peripheral angioplasty/stenting, fistulaplasty, Increased job satisfaction for staff and positive feedback nephrostomies, CT guided injections and various tube from service users. exchanges (gastrostomy, nephrostomy and biliary).

Beyond vascular access and diagnostic imaging, Nurses had one case each of: tube exchange (gastrostomy, nephrostomy and biliary); IVC filter insertion and US guided drainage. CONCLUSION Training and Assessment Advanced Practice is, and has for some time, been a feature • Training was described as being “in house, by clinicians” of IR. However, there is scant literature to support or promote (90.7%, n=39) or “in house, by existing Advanced it. The findings of this survey demonstrate the depth and Practitioners” (37.2%, n=16). Figure 3 breadth of practice within IR in the UK. Advanced Practitioners • Only 20.9% (n=9) required post graduate qualification. working in IR - with the support of bodies like SIRNR, BSIR • Assessment was predominantly by continuous audit (86%, CONTACT and the SCoR - need to produce and publish the evidence n=37). For further information please contact: base to support their practice and shape its future [email protected] or 0161 2768588 development.

REFERENCES 1. Patterson A. Role Development—Towards 2000. London: College of Radiographers, 1995. 6. The Society and College of Radiographers. Scope of radiographic practice survey 2012. London: Society and College of 2. Nightingale J. and Hogg P. Clinical practice at an advanced level: an introduction. Radiography. 2003; 9, 77-83. Radiographers, 2012. 3. Kelly J, Piper K, Nightingale J. Factors influencing the development and implementation of advanced and consultant radiographer 7. Survey Monkey, Inc. Palo Alto, California, USA. www.surveymonkey.com practice: A review of the literature. Radiography 2008; 14, 71-78. 8. Bowling A (2009) Research Methods In Health: Investigating Health and Health Services. P221. Open University Press; 4. Hardy M, Spencer N, Snaith B. Radiographer emergency department hot reporting: An assessment of service quality and feasibility. Maidenhead, Berks Radiography 2008; 14, 301-305. 9. Hoddes R, Hamlett G (2013) Call to All (Interventional) Radiographers in Synergy Magazine. Issue 108, September 2013. 5. Booth AM, Mannion RAJ. Radiologist and radiographer perception errors in reporting double contrast barium enemas: a pilot study. SCoR; London. Radiography 2005; 11, 249-254. 10. Twitter, Inc. San Francisco, California, USA. www.twitter.com