This issue highlights various quality improvement projects that were presented during the 2nd Annual Quality Improvement Forum at the 2025 Annual Scientific Meeting in Nashville.
Interventional radiology team members at the University of Rochester Medical Center in Rochester, NY, have implemented a cardiac arrest model and code simulation to improve timing, accuracy and staff comfort.
“I come from a critical care background, and when I transitioned to my role in IR, I saw an opportunity to improve our code response,” said Shannon Woughter, PA. “We often don’t have a lot of training on our code responses—however, we are taking care of increasingly sicker patients that need more medical care. When you work in a large medical center, sometimes it takes a few minutes for the code team to arrive. Those first couple of minutes are essential for good patient outcomes.”
According to Woughter, there are over 200,000 hospital cardiac arrests annually, and these happen within the IR suite as well. With this in mind, there was a need to be better prepared.
Woughter, along with Lindsay Marchetti, PA; Charles Gorton, RN; Lisa M. Owen, RN; Adrienne Conrad, RN; Marco Ertreo, MD; and Andrew Cantos, MD, utilized simulation equipment from the cardiac ICU team to design and implement IR code simulations.
All staff members were preassigned roles to focus on, such as code leader, administering CPR, documenting, or administering medications or the defibrillator. They then wrote simulations for scenarios that commonly happen, posing some IR-specific issues with cardiac arrest, and then ran five successful code simulations over a 10-month period.
“One simulation that we felt was really helpful was a prone CT lung biopsy scenario,” Woughter said. “Essentially, the patient has arrested faced-down on the table—how can we flip them over quickly to start CPR, place pads and defibrillate them? Another scenario involved line placement with a tunnel line and focused on how quickly you could get out of the procedure and start CPR.”
The team also explored a simulation that took place in the recovery area. “In that scenario, a patient comes in for a routine procedure and then suddenly collapses. So how do we manage this in an outpatient area where we don't have a lot of staff available quickly?”
In addition to tracking the time to CPR and defibrillation, the team also provided a 16-point survey that allowed staff to evaluate their experiences pre-and post-simulation. Respondents were asked to rank their confidence and comfort with roles, code algorithms and expectations.
“We found that as we ran these simulations, staff confidence increased,” Woughter said.
One surprising finding was a decrease in staff’s ability to find the code cart—though Woughter viewed this as an opportunity.
“It let us know what was a pain point and helped us provide better education and structure for improvement,” she said.
Overall, they found that the regular code simulations improved team organization, confidence and communication, as well as decreasing time to CPR—factors that contribute to better patient outcomes.
Woughter said the team plans to run more simulations in the future and will expand what departments they work with.
“Our hope is to work with trauma, who does a lot of simulations, so we can do ASSERT response, which is our critical embolization response,” she said. “With that, we could start a simulation in the emergency department with a theoretical patient who has a bleed and then progresses to the IR suite where they have a cardiac response. With this scenario, we could work with a lot of different teams.”
Woughter also hopes to collaborate with the cardiac ICU team, which occasionally runs ECMO simulations, as it is not unheard of for a patient to be put on ECMO in the IR suite.
This multidisciplinary team approach is key to running effective simulations, Woughter said.
“The simulation equipment is expensive, so if someone in your facility already has it and knows how to use it, collaborating with them will make this project significantly easier.”
She also encourages other IR teams who may be interested in establishing their own models to not be held back by concerns that IR is too specialized to effectively run codes.
“Using a team approach is what will put you ahead and push you forward to take care of these complex, sick patients,” she said. “We shouldn’t be afraid to talk about what we don’t know—that’s how we get better.”
Want more quality improvement content? The Quality Improvement in Interventional Radiology course is free to members and equips participants with the knowledge and skills necessary to successfully initiate, execute and evaluate QI projects.
The course has two parts: building the framework and implementing action. The module emphasizes the use of the Plan-Do-Study-Act (PDSA) cycle for iterative improvement and teaches how to evaluate the scalability of projects across healthcare settings. Participants will also develop leadership skills for driving change and engage staff effectively in continuous improvement efforts—all while aligning project timelines with organizational goals and milestones.
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