How Radiology Departments Must Adapt in Response to COVID-19

Have you ever had to adapt the way you do things? Was it easy? Were you glad you had to adapt? Why or why not?

Today, with COVID-19, things are rapidly changing, not only in healthcare, but in the entire world. And it seems like change has become the new constant. Many people do not like or appreciate change. However, without change, we can never get better. How have things changed in light of COVID-19 for radiology?

Radiology, for the most part, has shifted from being a diagnostic resource to being in a constant state of preparedness. According to a recent article in Radiology, the journal published by the RSNA, "Radiology preparedness is a set of policies and procedures directly applicable to imaging departments designed:

    a)   to achieve sufficient capacity for continued operation during a health care emergency of unprecedented proportions,

    b)   to support the care of patients with COVID-19, and

    c)   to maintain radiologic diagnostic and interventional support for the entirety of the hospital and health system."¹

So what should a shift to "radiology preparedness" look like? What does it mean to your department?

Pandemic Preparedness is the New Reality

1. Case prioritization

First, it means that routine exams are postponed in order to accommodate the more urgent cases.

2. Exam workflow

Pre-Screening: All patients are screened at least three times before their exam. Patients should be pre-screened on the phone a day prior to scheduled appointments. Patients should be screened upon entering the hospital, and again at check-in. If the patient presents with a fever or has a history of a known positive exposure to the coronavirus, they should be given a mask to wear, and be quickly isolated from other patients. The patient's doctor should be notified about the concern to determine if the procedure can be postponed.

According to a Radiology Scientific Expert Panel, "imaging [should be] reserved for those cases where it will impact patient management and is clinically indicated or to evaluate for unrelated urgent/emergent indications. This is typically in cases where an alternative diagnosis is being ruled out or being considered for acute symptom worsening."²

COVID-19 Patient Admission: For patients with suspected exposure to, or who present with symptoms of, or have a positive diagnosis of the coronavirus, who require treatment, all staff involved in the care of the patient will be required to wear the appropriate personal protective equipment (PPE): gloves, gown, mask, and goggles or face shield.

Patient Travel: Patient travel must also be considered to prevent the patient from crossing paths with inpatients within the hospital.

Room Sanitation: After the exam or procedure, the room is to be completely disinfected prior to bringing in a new patient. However, prior to sanitizing the room, there is a required downtime. In a negative pressure room, the downtime is up to 30 minutes after each patient. If the room is not a negative pressure room, the downtime can be up to 60 minutes between patients. Room decontamination should include all items in the room, including imaging equipment, keyboards, mice, telephones, door knobs, cabinetry doors, etc.

Inpatient and Emergency Department Examinations: For inpatients and emergency departments, portable exams should be performed at bedside when possible rather than transporting the patient to the department.

3. Entry protocols

Vendors should be restricted from entering the facility except for necessary equipment service.

4. Remote reading

When and where possible, radiologists should interpret remotely, either from home, or in a remote location. Ancillary staff that can work remotely should also be enabled to do so.

COVID-19 has certainly disrupted life in many ways. But, as with most disruptors in life, change can bring positive results in the end. I, for one, am looking for the positive changes that will come our way as a result of COVID-19.

More information regarding recommendations and resources can be found on the ACR website at: https://www.acr.org/Clinical-Resources/COVID-19-Radiology-Resources

_{^{1 https://pubs.rsna.org/doi/10.1148/radiol.2020200988
2 https://pubs.rsna.org/doi/10.1148/radiol.2020200988}}

_{^{Disclaimer: The content of this article is intended for informational purposes only, not advice or guarantee of outcome. It is not a substitute for guidance from public health authorities, professional medical advice, diagnosis, or treatment.}}

AUTHOR’S BIO:

Gar Bodenheimer brings more than 30 years of experience in radiology along with a proven track record of enhancing productivity and improving workflows. He has a demonstrated ability to improve employee satisfaction and build collaborative relationships while maintaining a clear focus on cost savings. Gar is committed to helping clients with organizational development and process improvement––the ultimate goal being the delivery of superior patient care.