IRQ Articles

Quality improvement 

10-09-2019 09:50

SIR Standards: Future directions

By Alda Tam, MD, MBA, FSIR, Zuhal Haidari, MPH, Sheena Patel, MPH, and Elizabeth Himes  Fall 2019

Over the past three years, the SIR Standards Division has undergone iterative reorganization to improve the impact of published documents. These changes have occurred on all levels: member engagement, staff resources and society leadership. In this article, we share some of the highlights that have guided the progress of SIR Standards.

Strategic direction

The Standards Division collaborates extensively with SIR leadership to ensure that published documents align with the society’s goals and strategic plan. Areas of priority include creating documents that meet the National Academy of Medicine (formerly the Institute of Medicine) standards to improve overall patient care and outcomes and move the society forward.

The Standards Division has a renewed focus on developing high-quality documents where IR is the leader in the field; therefore, the Standards Division is currently developing its first true clinical practice guideline (CPG) on inferior vena cava (IVC) filters in patients with thromboembolic disease. The CPG panel involves collaboration with the Society for Vascular Surgery, American College of Cardiology, American Heart Association/American Stroke Association, American College of Chest Physicians, Society for Vascular Medicine, American Society of Hematology and the American College of Surgeons Committee on Trauma.

The Standards Division reorganization has allowed SIR to prioritize documents that support emerging technologies and high-profile topics, including stroke treatment and prostate artery embolization. Moving forward, the strategy for published standards now aims to provide recommendations and support for IRs in all practice types. Future goals also include integration of standards recommendations with the IR quality registry.

Resources

As expectations for evidence-based guidelines increase, the need to base SIR’s standards on strong methodological rigor has become evident. Recognizing the need for this type of expertise and skill set, SIR has invested in the Standards Division by recently adding a methodologist staff member to guide the division in this process, with plans for additional staff to support the evidence-based research and writing process.

Methodologists, who are experts in guideline development and health research methods, implement a structured process for document creation which includes systematically gathering, assessing and synthesizing evidence that will inform graded recommendations. SIR’s methodologist, Sheena Patel, MPH, will help the division develop impactful evidence-based documents, including rigorous clinical practice guidelines.

Multidisciplinary collaboration

The Standards Division continues to seek out collaboration opportunities with other societies. SIR has longstanding relationships with international IR societies, including the Cardiovascular and Interventional Radiological Society of Europe (CIRSE) and the Canadian Association for Interventional Radiology (CAIR).

These collaborations provide a broader perspective on IR topics and how they are practiced globally. Recent multisocietal documents include position statements on prostatic artery embolization1 and acute stroke interventions2. The Standards Division is also working to increase collaboration with other specialty societies to make sure IRs are accurately represented in multispecialty documents.

Standards members can be nominated to writing panels and participate in peer-review processes for external documents before publication. To facilitate collaboration, SIR has a new endorsement policy allowing both official endorsement and affirmation of value of multisocietal documents that benefit IRs. Additionally, the Standards Division is actively including representatives from other specialties in current writing groups and peer reviews to foster cooperation in areas where multiple specialties intersect.

Standards Steering Committee

In 2018, the Standards Division introduced a new Steering Committee to lead the revision of previously published SIR standards documents. All documents published more than 5 years ago are being reviewed to ensure all content and recommendations are still accurate and relevant. The Steering Committee members each lead a workgroup of content experts to organize literature reviews and report any necessary updates. We would like to acknowledge the hard work and dedication of all members of the Steering Committee:

  • Brian J. Schiro, MD—Arterial workgroup
  • Mark O. Baerlocher, MD—Interventional oncology workgroup
  • Venu Vadlamudi, MD—Neuro and spine workgroup
  • Sean R. Dariushnia, MD, FSIR—Nonvascular workgroup
  • Anne Marie Cahill, MD—Pediatric workgroup
  • A.J. Gunn, MD—Portal workgroup
  • Christopher S. Morris, MD, FSIR—Renal workgroup
  • T. Gregory Walker, MD, FSIR—Safety and professional development workgroup
  • Suvranu Ganguli, MD, FSIR—Venous workgroup
  • Olga R. Brook, MD, FSIR—Women’s health workgroup

Standards documents

Standards documents come in different types and formats depending on the information they convey. The table above describes the various components of each document type. All SIR standards require review by the relevant Standards committee workgroup and approval by the SIR Operations Committee. New standards are published in print and online in the society’s journal, the Journal of Vascular and Interventional Radiology. Updates and reviews of previously published documents may receive online-only publication and become an addendum to the original publication.

Document type

Description

Systematic literature search and review

Graded recommendations informed by quality of evidence

Assist in clinical decision-making

Consensus-based recommendations for new/emerging procedures lacking robust data

Clinical practice guideline

Provide recommendations about benefits and drawbacks of different care options intended to optimize patient care

Yes

Yes

Yes

No

Appropriate
use criteria

Specify situations where it is appropriate to perform a certain procedure

Yes

Yes

Yes

No

Position statements

Reflect the society’s opinion concerning areas of evolving clinical practice and/or technologies

Sometimes

Sometimes

Sometimes

Yes

Expert consensus statement

Provide guidance from experts in the clinical area

No

No

Sometimes

Yes

Quality improvement standards

Combine recommendations and performance measures
to provide thresholds
and guide clinical
quality improvement

No

No

Sometimes

Sometimes

Reporting standards

Define a set of vocabulary for processes and outcomes to standardize comparison of data across multiple studies

No

No

No

Yes

Competence and training statement

Make recommendations on training and competencies required for a given clinical topic, procedure or therapy

No

No

No

Yes

The future of SIR standards

The SIR Standards Division will continue to evolve to meet the needs of the society and its members. We thank the many volunteers who have served over the years and guided the committee to where it is now.

The is the final part in a series of three articles dedicated to the changes within the SIR Standards Division. You can read the first two parts at bit.ly/2pU2Qdr and bit.ly/2USnfBt.

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References

  1. McWilliams JP, TA Bilhim, FC Carnevale, et al., Society of Interventional Radiology Multisociety Consensus Position Statement on Prostatic Artery Embolization for Treatment of Lower Urinary Tract Symptoms Attributed to Benign Prostatic Hyperplasia: From the Society of Interventional Radiology, the Cardiovascular and Interventional Radiological Society of Europe, Societe Francaise de Radiologie, and the British Society of Interventional Radiology: Endorsed by the Asia Pacific Society of Cardiovascular and Interventional Radiology, Canadian Association for Interventional Radiology, Chinese College of Interventionalists, Interventional Radiology Society of Australasia, Japanese Society of Interventional Radiology, and Korean Society of Interventional Radiology. J Vasc Interv Radiol, 2019. 30(5): 627–637 e1.
  2. Sacks, D, H van Overhagen, WH van Zwam, et al., The Role of Interventional Radiologists in Acute Ischemic Stroke Interventions: A Joint Position Statement from the Society of Interventional Radiology, the Cardiovascular and Interventional Radiology Society of Europe, and the Interventional Radiology Society of Australasia. J Vasc Interv Radiol, 2019. 30(2): 131–133.
   

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