Getting Back Up To Speed

The COVID-19 pandemic has significantly impacted patient access to routine healthcare across the globe.  This is mainly due to the medical community prioritizing resources to fight the disease while attempting to keep non-emergent patients out of the medical setting where they can potentially come in contact with the virus.

Although many medical imaging procedures can be delayed for a brief period of time, many cannot.  Understanding that the need for certain procedures cannot be delayed, the American Society of Nuclear Cardiology (ASNC) and the Society of Nuclear Medicine and Molecular Imaging (SNMMI) have each published their own guidance and recommendations on how to continue to provide these medical services while minimizing staff and patient exposure to the virus. The ASNC and SNMMI recommend following the Centers for Disease Control (CDC) recommendations on general principles for reducing viral transmission. These recommendations include, but are not limited to: distancing, hand hygiene, using separate spaces for patients with known or suspected COVID-19, and ensuring supplies are available.

Although many parts of the country are still significantly impacted and are still sometime from returning to “normal operations”, there are other areas of the country that are preparing for a return to “normal operations”.  In advance of this the American College of Radiology (ACR), published their own guidance on May 7, 2020 on how to return back to these normal operations in a safe way in a publication titled “Safe Resumption of Routine Radiology Care during the COVID-19 Pandemic”.

The ACR indicated that “the risk from healthcare-acquired COVID-19 can be made very low for most diagnostic radiology examinations and interventional radiology procedures if appropriate safety measures are in place (screening, testing, infection control processes, PPE, {social distancing}, etc.)”. ¹

Returning the medical practice settings to full capacity will require taking extra precautionary measures to ensure continued healthcare worker and patient safety, while still remembering that COVID-19 can be transmitted by those who are asymptomatic. The plan and risk mitigation measures that your facility chooses will need to take the following factors into consideration when determining an effective strategy for managing COVID-19, as described in the guidance recommendations by ASNC and SNMMI. ²

• Availability of personal protective equipment (PPE)
• Local, state and federal government mandates
• Institutional regulatory guidance
• Local safety measures
• Healthcare worker availability
• Patient and healthcare worker risk factors
• Factors specific to the indications for radiology care
• Examination or procedure acuity
• Facility and infrastructure (i.e. waiting areas, facility navigation)

Individual healthcare institutions will need to map out their own unique path for reintroducing non-urgent radiology care, taking into consideration seven areas of interest as described by the College of Radiology. ¹

Enact safety measures

• Screen all individuals that enter your facility, implement universal masking of all patients and healthcare workers, clean and decontaminate patient care areas according to CDC guidelines.

Respect local pandemic statistics

• Reschedule time-insensitive care for two weeks post local peak of the pandemic, monitor your area to predict secondary and tertiary peaks of COVID-19, and prepare for repeat disengagement of non-urgent procedures if your area anticipates another peak.

Engage in risk-benefit decision-making

• Providers and other stakeholders should communicate openly when triaging non-urgent care, discuss if lower-risk diagnostic options can be utilized, and coordinate with institutions the plans for re-engaging ambulatory care.

Develop a tiered plan for re-engagement of non-urgent radiology care

• An example of a tiered approach would be: (1^st) urgent care, (2^nd) time sensitive but not urgent care, (3^rd) elective care, and (4^th) scanning participants for imaging trials.

• Manage accreditation and regulatory deferrals to avoid unintended lapses

Address the backlog of previously deferred and delayed care

• Consider extending operational hours to improve access and preserve social distancing, determine if prescheduled care is still needed, and modify procedures to decrease time.

Manage fear

• Provide calm fact-based information, indicate that COVID-19 transmission risk is low with appropriate safeguards, and indicate to patients the infection control processes that your facility is taking.

Many patients that were insured and had prior-authorizations prior to the COVID-19 pandemic, may now be uninsured and facing financial hardship in light of unemployment. Through clear communication, financial concerns can be addressed before the patient arrives.  

Click here to review the full pre-proof guidance in the Journal of the American College of Radiology, which offers a list of questions to consider when estimating the risk of contracting healthcare-acquired COVID-19. To review the Guidance and Best Practices for Nuclear Cardiology Laboratories during the Coronavirus Disease 2019 (COVID-19) Pandemic: An information Statement from ASNC and SNMMI please click here.

1. Davenport, M., Bruno, M., et al. ACR Statement on Safe Resumption of Routine Radiology Care During the COVID-19 Pandemic. [Journal pre-proof]. https://www.jacr.org/article/S1546-1440(20)30510-X/pdf. (7 May 2020).

2. Hicham Skali, Venkatesh L. Murthy, et al. Guidance and Best Practices for Nuclear Cardiology Laboratories during the Coronavirus Disease 2019 (COVID-19) Pandemic: An Information Statement from ASNC and SNMMI.

3. https://www.cdc.gov/coronavirus/2019-ncov/hcp/index.html (7 May 2020).