If you or your facility could benefit from the implementation of a standardized triage protocol, then researchers at the University of California, Los Angeles, would like to hear from you.
In 2024, a SIR Connect Open Forum discussion revealed that IRs across the country were struggling with inconsistency and a lack of consensus on what a gold-standard IR triage process should look like.
“Interventional radiologists demonstrate some of the most varied practice patterns in all of medicine. There is no ‘one-size-fits-all’ national standard,” said Jason Chiang, PhD, MD, and Elena Drews, MD, of UCLA’s Department of Radiology. “Minor procedures, like paracenteses and thoracenteses, may be done by IR in some places, but by medicine in others. Not to mention the variability in staffing, resource availability and equipment.”
However, other specialties have seen substantial results from establishing a standardized triage framework, and many feel that IR would benefit as well.
“The main benefits are twofold,” said Drs. Chiang and Drews. “First, it creates consistency and clarity in expectations for clinicians, trainees and referring teams. Second, it has the potential to improve patient care by reducing delays to treatment.”
Even a simple ranking or scoring system helps align priorities, streamline communication and ensures that the most urgent cases receive timely attention, they said. And over time, that consistency can serve to strengthen IR’s role and leadership in the hospital ecosystem as a team that delivers reliable, structured and life-saving care.
To make this a reality, Drs. Chiang and Drews, supported by Tyler Callese, MD, of UCLA, and Steven J. Citron, MD, FSIR, of Emory, have launched a research survey on IR triaging, with the hope of establishing a standardized system.
“What we are trying to do is not to eliminate the nuance between practices, but to create broad consensus that brings consistency and clarity, while still leaving room for local practice patterns and individual clinical judgement,” Drs. Chiang and Drews said. “Ultimately, the goal is to set shared expectations and create a framework that improves efficiency, communication, and more importantly—patient care.”
The first round of the survey has closed with 69 responses, but researchers have recently proceeded with round two, which includes changes based on feedback.
“For example, we added femoral artery access site pseudoaneurysm as a triage category based on suggestions from the community. We’re also working to refine and clarify clinical scenarios so the system can be easily used by anyone involved in triaging cases—whether that’s a trainee, an advanced practice provider or an attending physician,” they said.
Early review of the data has also reiterated how difficult it is to establish a standardized approach.
“One issue that has come up is the importance of clinical judgement in triaging patients,” Drs. Chiang and Drews said. “For example, a patient who has a traumatic active hemorrhage, who is hypotensive and tachycardic, is presumably more emergent than a patient with active bleeding whose vital signs are stable. Similarly, a patient with pyonephrosis will likely require more urgent a nephrostomy placement than a patient with hydronephrosis with no signs of sepsis.”
Some respondents have said that because these nuances, it is impossible to establish a standardized IR triage system. Drs. Chiang and Drews disagree.
“These differences occur in trauma and acute care surgery, and other specialties with triage guidelines as well,” they said. “We do not intend for our guidelines to represent a definitive standard of practice, but rather a framework and shared resource. Ultimately IRs will still need to use clinical judgement, but our hope is that the guidelines are a useful adjunct.”
Another concern expressed in survey responses is that by reducing clinical expertise to a set of procedures, IRs may ultimately make themselves a commoditized entity.
“Our argument against that is that the procedures themselves, regardless of where they fall within the triage system, still require clear clinical judgement, imaging and technical expertise, and management of complex decisions,” Drs. Chiang and Drews said.
Drs. Chiang and Drews ultimately plan to submit their findings and experience for publication. They also hope to present their results at SIR 2026, as well as set up another Town Hall discussion to gather more feedback and identify the best paths for implementation.
“In many ways, we view this initial system as just the first step — the foundation for what we hope will become a broad, impactful initiative that improves consistency, efficiency and patient outcomes across IR,” Drs. Chiang and Drews said.
Anyone interested in participating may currently submit their responses to round two of the survey, which has been amended to be shorter, easier-to-understand and more accessible for respondents.
“We know it will not capture everything that one encounters in the middle of the night,” Drs. Chiang and Drews said. “But we hope everyone participates in this second-round survey! The more responses we get, the better the system will be.”
Do you have feedback or questions? The survey creators welcome your thoughts. Feel free to reach out to Elena Drews, MD, at edrews@mednet.ucla.edu or Jason Chiang, PhD, MD, at CJChiang@mednet.ucla.edu.
