Is Your CT Suite Ready for a COVID-19 Surge?

Picture this: it’s been a long night. You’re the only radiologist in the building. And, somewhere around 3 a.m., you get the call from your emergency department (ED) that they’re sending 15 mass casualties your way for CT scans. These aren’t victims of a multi-car crash – they’re patients suspected of having COVID-19 infection.

Suddenly, your mind is racing. Scan time itself is minimal, but what about patient transport time? CT scanner disinfection time? Time to outfit both yourself and your technologists with the personal protective equipment (PPE) needed to shield yourself from possible infection?

You have to ask yourself – “Am I ready?”

Throughout the country, the COVID-19 outbreak is already in full-swing with the hardest hit areas being major municipalities, mainly New York City and the surrounding area. While the virus is present in all 50 states, not every hospital has seen its COVID-19 peak. Now is the time to prepare your radiology department for what’s coming.

In an effort to help, researchers from the University of South California published guidance in the Journal of the American College of Radiology that can lead you through proper preparation for the current mass casualty incident (MCI).

“Radiologists can play an important adjunct role in triaging and diagnosing patients during a mass casualty incident, including a COVID-19 outbreak,” wrote a team led by Lee Myers, M.D., assistant professor of clinical radiology at the Keck School of Medicine at the University of Southern California. “Even the most efficient radiology department will undergo tremendous stress when victims of a mass casualty flood the emergency department and, in turn, the radiology department.”

And, while the real-time reverse transcriptase polymerase chain reaction (RT-PCR) test is considered the gold standard for COVID-19 detection – and the American College of Radiology recommends against using CT scans to identify the disease – there could still be instances nationwide where hospitals will rely on imaging as a way to detect and triage patients.

“It is expected that there will be a significant interest in increasing the number of imaging studies ordered for suspected cases of COVID-19 from both emergency medicine departments and inpatient services,” they wrote.

Consequently, contended Myers’ team, each radiology department must have an MCI plan in place to handle the imaging influx.

Prep Time

Laying the right groundwork for communication will be critical to successfully managing and navigating the crisis, the team said. And, a good communication plan requires early identification of point people in each department, as well as what each area will need. If you have a standard radiology MCI plan, break it out and build on it.

• Talk with your hospital’s ED leadership to identify the overall MCI plan for viral outbreak, and identify a point-person to discuss policies and protocols around ED imaging.

• Reach out to your infectious disease department to identify a go-to person for instructions on cleaning your portable X-rays, ultrasound machines, and CT scanners. He or she can also offer guidance on how to protect yourself, your staff, and your patients.

• Work with environmental services staff to clarify procedures and time needed to clean your stationary imaging rooms. Get details about air exchange rates so you’ll know how long your rooms will be down between cleanings.

• Update all contact details – pager, home, and cell phone numbers – for radiology, ED, and infectious disease leadership. Be sure everyone talks at least once daily to evaluate and assess needs.

Mobilize Resources

Designating a radiology MCI manager who can oversee activities can keep your department running smoothly during the crisis.

“An MCI plan ‘manager’…will oversee radiology operations during a mass casualty scenario,” the authors wrote. “The radiology department MCI plan ‘manager’ will decide when radiology resources will be mobilized and the best use of these resources.”

In doing so, keep these points in mind:

• Use portable equipment to reduce the risk of transmission, and designate an appropriate number of X-rays to the ED.

• Dedicate at least one – multiple if you have them – CT scanners to patients suspected of having COVID-19.

• Clean all stationary equipment based on your institutional policies, according to your infectious disease department.

• Create an automated or manual system that can call in extra radiologists and staff if your department sees a significant surge and is in danger of becoming overwhelmed.

Clarify the Imaging Chain

According to the team, during a viral outbreak, your imaging chain is most vulnerable with patient transport to the radiology department and with cleaning equipment. Clearly outlining when imaging should be used and how it can be accomplished will prevent any overuse.

Remember you might have to make adjustments as patient volume changes, the team advised.

• Determine who will order imaging studies for patients suspected of COVID-19 and which patients should receive them.

• Create a protocol to decide between standard or low-dose CT.

• Choose someone to be in charge of scheduling and create a transport team.

• Create a post-procedure cleaning protocol.

• Decide whether you’ll convey results in a written or verbal format.

• Designate a waiting area for patients suspected of COVID-19 infection that keeps them at least 6 feet apart, and have them wear masks.

Educating Your Team

One of the biggest dangers present in a viral outbreak is a lack of understanding around personal and patient protection.

“Education has an important role in decreasing transmission rates and improving patient throughput efficiency,” the team wrote. “The use of proper precautions can help protect patients and radiology staff.”

• Wear PPE, including gowns, gloves, masks, and eye protection

• Clean equipment according to manufacturer instructions and your facility’s policies.

• Use portable equipment as much as possible to reduce transmission.

Practice

The best way to learn and prepare is by doing, and getting ready to handle a huge surge of patients in a viral outbreak is no different, the researchers wrote.

“The use of simulations can identify breakdowns and bottlenecks in the imaging chain,” they wrote. “This can also identify the minimum number of personnel needed from start to finish of the exam.”

• Run a simulation to pinpoint whether you need more staff. Think about turn-around-times, where patients should be imaged, and whether your waiting rooms will have enough capacity.

• Offer in-service training to technologists based on imaging specialty, as well as ancillary staff, patient transporters, and radiology supervisors.

• Clearly outline who to call if -- and when -- there’s an increased need for resources.

As the virus continues to spread nationwide, it’s highly likely that more radiology departments will find themselves faced with a surge of patients, requiring them to implement an MCI protocol. Prior planning can be critical to controlling the outbreak as much as possible.

“Having an MCI plan in place for a viral outbreak will protect patients and staff and, ultimately, decrease virus transmission,” the team wrote. “The radiology department should be ready to mobilize equipment and staff to meet the needs of our patients.”