Opening Your Doors for Non-Emergent Care: Expert Guidance

For nearly two months, much of radiology’s imaging volume has been sitting on the sidelines, waiting for the green-light for imaging centers to re-open their doors for non-urgent scans. While there’s no exact date that will work for everyone to begin elective imaging again, the time is coming when facilities may feel comfortable doing so.

But, before you raise the curtain on the growing backlog of studies, there are many safety, workflow, and personnel considerations you must address. To help you along the way, the American College of Radiology (ACR) released guidance Wednesday, in the Journal of the American College of Radiology, that can guide you to safely resuming non-emergent imaging.

“Radiology practices largely followed World Health Organization, Centers for Diease Control and Prevention (CDC) and ACR guidance to postpone non-urgent care,” said Jacqueline A. Bello, M.D., FACR, ACR chair of the Radiology Commission on Quality and Safety. “While local conditions prevent a single prescriptive strategy to resume such care, general principles can apply in most settings.”

Safety Precautions

There are many things that must factor into your decision on whether to re-open. Review your local statistics on current levels of viral presence and infection, and monitor that data in case it begins to indicate the emergence of a second- or third-viral wave. Make sure you’re abiding by both governmental and institutional regulations, and be prepared to disengage all non-urgent imaging if more cases emerge.

“To safely resume routine care, practices must balance local risk from illness or death to workers and patients from healthcare-acquired COVID-19 with the patient-specific risk of illness of death from postponing an examination or procedure,” wrote the panel of experts, led by Michael Davenport, M.D., from Michigan Medicine, responsible for drafting the ACR statement.

If conditions are favorable for you to start scanning patients for elective or non-emergent procedures again, the ACR recommended you enact these five over-arching safety measures:

1. Screening: Screen every patient for COVID-19 symptoms during scheduling, and screen them again, as well as workers and visitors, when they enter your building. Have a plan in place for how to manage people who screen positive, and devise a system to identify and flag any patients who have been previously infected with the virus.

2. Personal Protective Equipment (PPE): Be sure you have enough PPE for both workers and patients to meet both current and future needs. Require every patient, visitor, and healthcare worker to wear a mask, and train staff and providers on correct PPE use and hand hygiene. Also, ensure that you have PPE, such as N95 masks and powered air-purifying respirators, for aerosolizing care. And, coordinate with your health systems for PPE use, being sure to concentrate on the highest-risk care, and concentrate your activity in specific sites if there’s not enough PPE for you to re-start activity everywhere.

3. Social Distancing: Provide for adequate spacing in waiting rooms, hallways, and work areas. This can include one-way corridors to minimize unnecessary contact, as well as having patients wait in their cars until their appointment time arrives.

4. Efficiency: Designate care areas for patients who have or are suspected of having COVID-19, and restrict the number of visitors coming in with your patients. In addition, do not allow symptomatic visitors to accompany your patients. And, be vigilant about cleaning and decontaminating patient care areas routinely, following CDC guidelines.

5. Safe Working Environment: Draft and disseminate a plan for communicating safe best practices. Provide at-home work stations for providers when you can, and enable telehealth for pre- and post-procedures visits to ensure the safest ambulatory imaging for patients who have had recent COVID-19 infection.

Managing Patient Flow

Once you have these measure in place, your next challenge will be effectively and efficiently working through the large volume of backlogged cases. Developing a categorization system for slowly re-instating the workload can be helpful. For example, the ACR recommended this tiered system:

Tier 1: Urgent and emergent care
Tier 2: Non-urgent time-sensitive care
Tier 3: Elective care and screening
Tier 4: Research subjects for imaging trials

It’s also unlikely that you’ll be able to process the imaging volume in the most expeditious manner if you simply maintain your previous work schedule. At least for the foreseeable future, you’ll need to alter your work hours, the panel said. But, there are several things you can do to streamline the process:

• Extend your hours of operation, improving access and enabling social distancing

• Shorten imaging exams and procedures

• Modify scheduling grids to maximize social distancing

• Develop a system that enables your referring physicians to clearly communicate exam acuity

• Determine if any previously ordered care is now unnecessary and can be canceled

• Collaborate with your local competitors to smooth any access challenges

Alongside these recommendations, the ACR also provided a checklist of questions that can help you determine if you’re ready to re-open your doors to more patients. The list will walk you through all workflow, safety, and personnel factors.

Overall, the panel advised, be sure you work closely with the leaders of your hospital systems, your referring provides, and your patients to develop the safest, most effective care strategies.