Best radiology practices during Covid 19 crisis: Expert panel
OAK BROOK,Ill.-A panel of experts have released policies and recommendations on radiology preparedness during the coronavirus disease (COVID-19) crisis. The article outlines priorities for handling COVID-19 cases and suggests strategies that radiology departments can implement to contain further infection spread and protect hospital staff and other patients. The guidance has been published in the journal Radiology .
Fortunately infection rates have been brought under control in China where COVID-19 began in December 2019 but cases in Italy and Iran have increased exponentially.
Now that chest CT findings are no longer part of diagnostic criteria for COVID-19, the focus of most radiology departments has shifted from diagnostic capability to preparedness.
Radiology preparedness during this outbreak requires radiology department policies and procedures designed to have enough capacity for continued operation during a health care emergency of unprecedented proportions and to support the care of patients with COVID-19, while maintaining radiology support for the entirety of the hospital and health system.
Because of varying national and regional infection control policies, steps for radiology preparedness for COVID-19 will vary between institutions and clinics. The Radiology Editorial Board has assembled a team of radiologists who are active in coordination, development and implementation of radiology preparedness policies for COVID-19 at institutions or health care systems in Washington, New York, Georgia, California, Wisconsin and Singapore. Their policies have been developed in conjunction with infection control experts within their institutions.
In the article, each panel member describes their department's top priorities for COVID-19 preparedness in their environment and the steps that have been implemented to address those priorities.
The group listed the following best practices:
Limit exposure to the virus.
Use screeners at all hospital entrances, as well as the radiology reception desk, to check for symptoms that could be related to the coronavirus.
Put protocols in place for patients with known or suspected coronavirus to direct them appropriately to virtual urgent care, the emergency department, or radiology.
Determine best use of imaging.
Diagnostic laboratory tests have a sensitivity of 95% to 97%, with quick turnaround time, and should be used first.
Reserve imaging for suspected coronavirus cases for which it will affect patient management or for which an alternative diagnosis must be ruled out.
Protect staff.
Mask patients during imaging and procedures.
Deep clean the scanner and room after imaging and allow for passive air exchange.
Use appropriate precautions for patients who are undergoing aerosol-generating procedures.
Establish drive-through testing sites.
Issue a moratorium on travel for all employees for one month.
Maintain supply of N-95 masks and other personal protective equipment.
Provide infection control tutorials, especially to CT, ultrasound, and interventional technologists.
Maintain radiology department operations.
Establish a coronavirus crisis imanagement team that oversees the department's preparedness.
Develop a plan for separate urgent care sites for treating coronavirus patients.
Put social distancing measures into place: Allow staff to work from home, create isolated reading rooms onsite, and use video conferencing for meetings. Do not allow staff to rotate between facilities.
Quarantine staff after travel to level 3 countries (those with widespread, ongoing transmission) or exposure to patients with suspected coronavirus.
Create a plan to handle surge if the healthcare system is burdened by increased patient volume and imaging needs.
Create a backup call schedule to cover for ill staff.
"The Editorial Board hopes that readers may find similarity of the highlighted healthcare systems to their own environment, providing impetus for action or confirmation of their current preparedness activities," said David A. Bluemke, M.D., Ph.D., Radiology Editor and professor in Department of Radiology at University of Wisconsin School of Medicine and Public Health in Madison.
Priorities for COVID-19 preparedness vary among health care systems, but focus on early detection, limiting virus exposure to others, safety precautions, cleaning protocols, training, and maintenance of operations and staffing.
Western Washington state is the epicenter of the COVID-19 outbreak in the U.S. At University of Washington Medicine, the hospitals have begun screening at the high-flow main hospital entrances to check those coming in for symptoms that could be related to coronavirus infection or with risk factors related to travel or exposure.
"The radiology front desk serves as an additional screening site, with similar screening to that performed at the hospital front door," said Mahmud Mossa-Basha, M.D., associate professor of radiology at University of Washington School of Medicine in Seattle. "Patients who come in with respiratory symptoms who are undergoing outpatient imaging or procedures have their imaging exams canceled and are asked to follow up with their primary care physician."
Even after the outbreak subsides, radiology departments must continue to plan and prepare for future outbreaks and pandemics. At Singapore General Hospital, long-range planning for COVID-19 is considered a new norm for radiology operations.
"We are re-thinking how radiology can deliver optimal imaging and treatment while reducing unnecessary movement and congregation of patients within our hospital environment," said Bien Soo Tan, M.D., chair of the Division of Radiological Sciences at Singapore General Hospital. "Teleconsultation and electronic smart appointment applications and counselling are being fast tracked for implementation and will have far reaching impact on our future practice."
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