We don't refer to those IRs. There are multiple spine groups (ortho and neuro spine) willing to inject cement who we refer to instead. It's the hospitalists and med oncs who place the referrals to IR who often never even call rad onc.
The reason for this is because here in weird academics land, when the hospitalist puts in a consult for IR, the IR mid-level or fellow shows up quickly after the consult is placed with a smiling face and takes care of things. The hospitalists know exactly who the IR is or mid-level is who will take care of their consult because it's basically only one of them who does the kyphos plus the IR mid-level typically does all the inpatient consults. So it's easy for them to curbside and they know who's responsible for the consult and who to contact for any follow-up.
Meanwhile, a different rad onc attending is responsible for inpatient consults based on day or even time of day (morning or PM coverage). Inpatients are usually staffed as attending only without midlevel/resident support. The rad oncs often have to see the consult end of day or next morning due to high volume of clinic patients. The academic rad onc may not be very happy to even get the inpatient consults. That rad onc might not be at the hospital very often, and the cast and crew taking care of inpatients changes all the time. Further, multiple hand-offs often take place, which makes it hard for the hospitalists to know who to contact, curbside, or follow-up with.
At the end of the day, we provide poor customer service to the inpatient teams and lose patients. Every once and awhile departmental leadership groans at us about this, we tell them to provide us a consistent inpatient service, they tell us no, and the status quo continues. This is the same reason why neurosurgery gets consulted for every brain met, even if the patient is clearly not a surgical candidate. They have a resident service responsible for seeing every inpatient consult, no matter the reason, so it's easy for the referring services to place the consult and have something happen quickly.
unless on clinical trial based on current evidence.
I proposed a randomized clinical trial to the IR who does the cement/RFA alone. No way that's going to happen. Surgeons and other proceduralists seem to have no problem just going off and doing things, then writing retrospective series to justify it later.
