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Published on: May 3, 2017
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Nerve root injection cancellations because of incomplete anticoagulation management
Elizabeth Robinson1, Shahab Shahipasand2, Panagiotis Liantis3
1Foundation Year 2 Doctor, Department of Radiology, Guy's and St Thomas' Foundation Trust, London SE1 7EH.
Summary
A new electronic request form significantly reduced cancellations for computed tomography-guided nerve root injections by ensuring proper anticoagulation management. This intervention eliminated procedure cancellations due to anticoagulation issues, improving patient care and service efficiency.
Area of Science:
- Interventional Radiology
- Pain Management
- Health Services Audit
Background:
- Computed tomography (CT)-guided steroid injections are standard for spinal pain from facet arthropathy and radiculopathy.
- Epidural hematoma is a rare but serious complication, contraindicating anticoagulation during the procedure.
- Outpatient procedures require careful peri-procedural anticoagulation management by referring physicians, with anecdotal evidence of increased cancellations.
Purpose of the Study:
- To audit the incidence of CT-guided nerve root injection cancellations due to anticoagulation management.
- To develop and implement an intervention to reduce these cancellations.
- To re-audit the effectiveness of the intervention.
Main Methods:
- An audit standard was set for 100% of outpatients to have an appropriate anticoagulation plan.
- Baseline data collected prospectively (Sept-Nov 2016) for CT-guided spinal injections.
- Intervention: A revised electronic request form with mandatory fields for antiplatelets and anticoagulants was implemented. Re-audit data collected (Sept-Nov 2017).
Main Results:
- Baseline audit: 5% (3/55) of patients had cancellations due to anticoagulation management.
- Post-intervention re-audit: 0% cancellations (0/93) were recorded.
- The intervention successfully eliminated cancellations related to anticoagulation management.
Conclusions:
- The revised electronic request form effectively prevented cancellations for CT-guided nerve root injections.
- This intervention improved service efficiency by reducing lost procedure slots.
- Potential annual savings of £3445.56 were estimated due to preventing cancellations.
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