Degeneration (Lumbar)|Percutaneous Facet Fusion|74|Male
Degeneration (Lumbar)|Percutaneous Facet Fusion|74|Male
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4 grade of Pfirrmann in L5S1, with discogenic and facet pain, with failure of medical and physical treatment.

And we choose another type of screws, dynamic screws. Not for fixation, but we put the screws under the facet. It's composed by a titanium anchor and a polyurethane stabilizer. The access kit is very similar to previous, but the technical is

a little bit different because we put the access needle, Kirschner wire, dilators, and the tap, and a countersink to create a space for the screws. But when we put the anchor and the stabilizer, we put the screws under the facet. Not to fix them, but to obtain a push up,

a superior push up of the facet and to limit the hyperextension. Then we repeat the procedure on the other pedicle. This is the final position of the implant, and the CT check. We can appreciate

the difference. Here the screws is under the facet not through the facet, as the case before, and the CT check confirms the correct implant of the screws. We also evaluate patient in the study with a two-year follow up.

We had a good reduction of pain evaluated by means of VAS score, and functions by means Oswestry. So we demonstrated that Percudyn system was a good

So IRs are now capturing the majority of the referrals

from non-procedure based specialists. So oncologists, pediatricians, primary care physicians, right? And I talked about the success interventional cardiology has had in terms of identity. Another factor in terms of this success

is the fact that their colleagues, their cardiology colleagues and non-procedural cardiology colleagues refer patients to them. So they work hand in glove, right? So what's different in radiology, our diagnostic radiology colleagues are not accustomed to

making referrals to interventional radiology. Now there are some, they rely on the referring physician who's ordered the exam to do that. But there are groups across the country that are starting to work with their diagnostic colleagues so that at the end of a procedure

they will maybe make a recommendation to consult interventional radiology. So if you think about it if a diagnostic radiologist sees pelvic congestion or sees fibroids on a scan how valuable would that be if they were to, say,

consult conventional radiology for consult? But your diagnostic radiology colleagues also need to know what you can do. And so that's all part of that education with them. So they're not going to refer a case if they don't even know that you have

that capability to do that. And then of course there's the patient-driven growth by consumers. And this little cartoon is funny. If you can't read it, it says, "I already diagnosed myself "on the Internet, I'm only here for a second opinion."

(audience laughing) So patient-driven growth is achieved by appealing to consumers who are shopping for non-surgical alternatives online. And so patients are taking a leading role in their health care decision.

MIIPs are often cheaper and have a shorter recovery time. We've established that and we established that they value that. So it is with consumers that you and your colleagues have great opportunity to promote yourself. And indeed that is what we are doing

at the Interventional Initiative. We're really focusing on the consumers and on our potential customers outside. And we're struggling to communicate value. Just the word "Radiology Department," we know that that generally

diagnostic radiology and interventional radiology all fall under that same title. And often referring physicians and even administrators view them as analogous in terms of role and resources. And so that's really just not true. Now there may be some organizations

where interventional radiology falls under a service line, a cardiovascular service line, and maybe they have a little bit easier time with their identity there within their hospital. But this is a great opportunity, I think, to really kind of dive into that

and really explore opportunities with your diagnostic colleagues. Again as I mentioned before IR is a referral-dependent specialty. So we also have the problem of physicians who were potential referring physicians

that don't know that we can do what we can do and they send patients out to other facilities. And so it's important, I think, that IR physicians participate on tumor boards, on hospital quality management committees and things like that that help build credibility

and help capture referrals just by having an opportunity to share the story. And as a former Service Line Director I have the notion that administrators sometimes are leery about investing resources when they don't see the growth potential.

I mean they really understand the growth potential within cardiology and the need to hang on to market share for cardiology and obstetrics. Now the advisory board has done a really great job over the last several years producing materials about interventional radiology

as a growth center and hopefully your administrators are cued into that.

So now I'm going to talk a little about the Interventional Radiology Practice Council. IR is a unique modality, because the way the organization is structured, it is the home base for the nurses.

So there might be Imaging nurses, they do go other Imaging modalities, but they are hired and sit structurally within Interventional Radiology. Across the rest of the organization, inpatient clinical errors have Unit Councils,

and this Unit Council is where the voice of Nursing is heard, where Nursing issues are discussed, and where any practice changes that impact patients across the whole organization are discussed. So the Practice Councils provide leadership

for decision making, expert consultation towards achieving and sustaining academic practice, and quality work environments. In order for the voice of IR Nurses to be heard, we needed our very own Practice Council as well because that is why we hear what is going on.

What are the floor issues happening? To fit with that structure of the organization, that is why we develop on IR Practice Council. So the Unit Council members identify and bring forward any practice issues identified by nurses in the area they represent

that have a UHN-wide impact on nursing. The IR Practice Council attends the Bi-Monthly PNPC to report any issues they have the area, but it's also an opportunity to innovate, an opportunity to hear what other people are doing, and bring that to your area.

So these are the terms of reference. Nothing for you to focus on too much. What's important to know about the terms of reference is that the IR Practice Council is chaired and co-chaired by a point-of-care nurse.

So anyone in a leadership role, a supervisory role, a manager role is not allowed to be the chairperson. This is designed for and is intended for the point-of-care clinician. If you are in leadership, like myself,

you are a manager, you are welcome to attend. You can be member, but you cannot be the chairperson. That's what's important to see and to know about this.

So are you telling your story with regards to outcomes? And this is kind of a difficult thing in interventional radiology because there is no special center of excellence designation for anything that we do and not everybody's even participating

in the data systems like with the NCDR. So they're not even capturing the outcomes and benchmarking against the national database. When we interviewed (coughs), excuse me, (clearing throat) we did a survey of consumers and we asked them the question, "Hospitals that receive extra accreditation or certification

"in addition to that provided by the Joint Commission "provide higher quality of care "than those who do not." We asked them how they felt about that statement and you can see that 25% strongly agree and 40% mildly agree.

So that, when you have extra designations like cardiology has Get with the Guidelines for everything, patients pay attention to that. And we kind of went even a little step further and asked them how they felt about this statement. "I would go out of my way to receive care

"at such a place even if it meant "traveling farther than my local hospital." Over 50% of the patients said they would travel 20 to 50 miles away from their local hospital if they had a center that was recognized. So we need as a specialty

to start really thinking about this and what can we do to add that edge, that competitive edge, when we're trying to attract patients to us.

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